Öz
Amaç: Sevk alan üçüncü basamak merkezimizde yapılan elektif ve acil servikal serklaj sonuçlarını incelemeyi ve etkinliklerini değerlendirmeyi amaçladık
Gereçler ve Yöntem: Bursa Yüksek İhtisas Eğitim ve Araştırma Hastanesi’nde Ocak 2016 ile Ocak 2020 arasında servikal yetmezlik tanısıyla servikal serklaj yapılan toplam 56 hastanın sonuçları retrospektif olarak incelenmiştir. Transvajinal olarak Mc-Donald tipi serklaj uygulanan hastalar çalışmaya dahil edilmiştir. Çoğul gebeliği olan, abdominal serklaj uygulanan ve doğum sonuçlarına ulaşılamayan hastalar çalışma dışı bırakılmıştır. Serklaj yapılma endikasyonuna göre hastalar; elektif serklaj (öykü endikasyonlu) ve acil serklaj (fizik muayene ve ultrasonografi endikasyonlu) olmak üzere iki grupta incelenmiştir.
Bulgular: Serklaj işleminin yapıldığı gebelik haftası elektif ve acil grupları için sırasıyla 20.8±0.7 ve 13.9±0.1 hafta olarak saptandı. Elektif serklaj yapılan grupta serklaj işlemi ile doğum arasında geçen süre ile doğumun gerçekleştiği hafta belirgin olarak daha fazlaydı (151.1±6.5 gün / 35.2±0.9 hafta vs 23.7±18.5 gün / 26.6±1.4 hafta ). Bununla ilişkili olarak da doğum ağırlığı elektif serklaj yapılan grupta acil serklaj yapılan gruptan anlamlı olarak daha fazlaydı ( 2913.7±129 gr vs 1611.4±232.2 gr). Yenidoğan yoğun bakım gereksinimi ise elektif serklaj grubunda daha azdı. Doğum şekli ve abortus oranı açısından ise her iki grup arasında istatiksel anlamlı fark yoktu.
Sonuç: Ağrısız servikal açıklık ile başvuran ya da ultrasonografide belirgin kısa servikse sahip hastalarda yapılan acil serklaj da elektif serklaj kadar olmamakla birlikte gebelik süresini uzatmada ve kötü perinatal sonuçları azaltmada etkilidir. Elektif serklaja kıyasla acil serklaj etkinliğini belirlemek için acil serklaj uygulanan hastaların daha iyi randomize edildiği daha fazla hasta sayısı ile yapılacak prospektif çalışmalara ihtiyaç vardır.
Anahtar Kelimeler
Kaynakça
- 1. Stupin JH, David M, Siedentopf J-P, Dudenhausen JW. Emergency cerclage versus bed rest for amniotic sac prolapse before 27 gestational weeks: a retrospective, comparative study of 161 women. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2008;139(1):32-7.
- 2. McNamee KM, Dawood F, Farquharson RG. Mid-trimester pregnancy loss. Obstetrics and Gynecology Clinics. 2014;41(1):87-102.
- 3. Obstetricians ACo, Gynecologists. ACOG Practice Bulletin No. 142: Cerclage for the management of cervical insufficiency. Obstetrics and gynecology. 2014;123(2 Pt 1):372-9.
- 4. Vyas NA, Vink JS, Ghidini A, Pezzullo JC, Korker V, Landy HJ, et al. Risk factors for cervical insufficiency after term delivery. American journal of obstetrics and gynecology. 2006;195(3):787-91.
- 5. Iwahashi M, Muragaki Y, Ooshima A, Umesaki N. Decreased type I collagen expression in human uterine cervix during pregnancy. The Journal of Clinical Endocrinology & Metabolism. 2003;88(5):2231-5.
- 6. Final report of the Medical Research Council/Royal College of Obstetricians and Gynaecologists multicentre randomised trial of cervical cerclage. MRC/RCOG Working Party on Cervical Cerclage. British journal of obstetrics and gynaecology. 1993;100(6):516-23.
- 7. Berghella V, Keeler SM, To MS, Althuisius SM, Rust OA. Effectiveness of cerclage according to severity of cervical length shortening: a meta-analysis. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2010;35(4):468-73.
- 8. Berghella V, Odibo AO, To MS, Rust OA, Althuisius SM. Cerclage for short cervix on ultrasonography: meta-analysis of trials using individual patient-level data. Obstetrics and gynecology. 2005;106(1):181-9.
- 9. Ehsanipoor RM, Seligman NS, Saccone G, Szymanski LM, Wissinger C, Werner EF, et al. Physical Examination-Indicated Cerclage: A Systematic Review and Meta-analysis. Obstetrics and gynecology. 2015;126(1):125-35.
- 10. Paton MC, McDonald CA, Allison BJ, Fahey MC, Jenkin G, Miller SL. Perinatal brain injury as a consequence of preterm birth and intrauterine inflammation: designing targeted stem cell therapies. Frontiers in neuroscience. 2017;11:200.
- 11. Sciscione AC. Maternal activity restriction and the prevention of preterm birth. American journal of obstetrics and gynecology. 2010;202(3):232. e1-. e5.
- 12. Grobman WA, Gilbert SA, Iams JD, Spong CY, Saade G, Mercer BM, et al. Activity restriction among women with a short cervix. Obstetrics and gynecology. 2013;121(6):1181.
- 13. Berghella V, Rafael TJ, Szychowski JM, Rust OA, Owen J. Cerclage for short cervix on ultrasonography in women with singleton gestations and previous preterm birth: a meta-analysis. Obstetrics & Gynecology. 2011;117(3):663-71.
- 14. Chatzakis C, Efthymiou A, Sotiriadis A, Makrydimas G. Emergency cerclage in singleton pregnancies with painless cervical dilatation: A meta‐analysis. Acta Obstetricia et Gynecologica Scandinavica. 2020;99(11):1444-57.
- 15. Hashim HA, Al-Inany H, Kilani Z. A review of the contemporary evidence on rescue cervical cerclage. International Journal of Gynecology & Obstetrics. 2014;124(3):198-203.
- 16. Harger JH. Cerclage and cervical insufficiency: an evidence-based analysis. Obstetrics and gynecology. 2002;100(6):1313-27. 17. Chen Q, Chen G, Li N. Clinical effect of emergency cervical cerclage and elective cervical cerclage on pregnancy outcome in the cervical-incompetent pregnant women. Archives of gynecology and obstetrics. 2018;297(2):401-7.
- 18. Gluck O, Mizrachi Y, Ginath S, Bar J, Sagiv R. Obstetrical outcomes of emergency compared with elective cervical cerclage. The Journal of Maternal-Fetal & Neonatal Medicine. 2017;30(14):1650-4.
- 19. Wang S, Feng L. A single‐center retrospective study of pregnancy outcomes after emergency cerclage for cervical insufficiency. International Journal of Gynecology & Obstetrics. 2017;139(1):9-13.
- 20. Oh KJ, Romero R, Park JY, Lee J, Conde-Agudelo A, Hong J-S, et al. Evidence that antibiotic administration is effective in the treatment of a subset of patients with intra-amniotic infection/inflammation presenting with cervical insufficiency. American journal of obstetrics and gynecology. 2019;221(2):140. e1-. e18.
- 21. Mönckeberg M, Valdés R, Kusanovic JP, Schepeler M, Nien JK, Pertossi E, et al. Patients with acute cervical insufficiency without intra-amniotic infection/inflammation treated with cerclage have a good prognosis. Journal of perinatal medicine. 2019;47(5):500-9.
Öz
Aim: We aimed to examine the elective and emergency cervical cerclage results performed in our referral tertiary care center and evaluate their effectiveness.
Materials and Methods: The results of 56 patients who underwent cervical cerclage with the diagnosis of cervical insufficiency in Bursa Yüksek İhtisas Training and Research Hospital between January 2016 and January 2020 were retrospectively analyzed. Patients who underwent Mc-Donald type transvaginal cerclage were included in the study. Patients with multiple pregnancies, abdominal cerclage, and deliver results that could not be reached were excluded from the study. According to the cerclage indication, patients were examined in two groups as elective cerclage (with history indication) and emergency cerclage (with physical examination and ultrasonography indication).
Results: The gestational week when cerclage was performed was determined as 20.8 ± 0.7 and 13.9 ± 0.1 weeks for elective and emergency groups, respectively. In the elective cerclage group, the time between cerclage procedure and delivery and the week of delivery was significantly higher (151.1 ± 6.5 days / 35.2 ± 0.9 weeks vs. 23.7 ± 18.5 days / 26.6 ± 1.4 weeks). In relation to this, birth weight was significantly higher in the elective cerclage group than in the emergency cerclage group (2913.7 ± 129 gr vs. 1611.4 ± 232.2 g). Neonatal intensive care requirement was less in the elective cerclage group. There was no statistically significant difference between the two groups in terms of delivery method and abortion rate.
Conclusion: Emergency cerclage performed in patients presenting with painless cervical aperture or having a prominent short cervix on ultrasonography effectively prolongs gestational period and reduces poor perinatal outcomes, although not as much as elective cerclage. There is a need for prospective studies to determine the efficacy of emergency cerclage compared to elective cerclage, in which patients with emergency cerclage are better randomized and with a larger number of patients.
Anahtar Kelimeler
Kaynakça
- 1. Stupin JH, David M, Siedentopf J-P, Dudenhausen JW. Emergency cerclage versus bed rest for amniotic sac prolapse before 27 gestational weeks: a retrospective, comparative study of 161 women. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2008;139(1):32-7.
- 2. McNamee KM, Dawood F, Farquharson RG. Mid-trimester pregnancy loss. Obstetrics and Gynecology Clinics. 2014;41(1):87-102.
- 3. Obstetricians ACo, Gynecologists. ACOG Practice Bulletin No. 142: Cerclage for the management of cervical insufficiency. Obstetrics and gynecology. 2014;123(2 Pt 1):372-9.
- 4. Vyas NA, Vink JS, Ghidini A, Pezzullo JC, Korker V, Landy HJ, et al. Risk factors for cervical insufficiency after term delivery. American journal of obstetrics and gynecology. 2006;195(3):787-91.
- 5. Iwahashi M, Muragaki Y, Ooshima A, Umesaki N. Decreased type I collagen expression in human uterine cervix during pregnancy. The Journal of Clinical Endocrinology & Metabolism. 2003;88(5):2231-5.
- 6. Final report of the Medical Research Council/Royal College of Obstetricians and Gynaecologists multicentre randomised trial of cervical cerclage. MRC/RCOG Working Party on Cervical Cerclage. British journal of obstetrics and gynaecology. 1993;100(6):516-23.
- 7. Berghella V, Keeler SM, To MS, Althuisius SM, Rust OA. Effectiveness of cerclage according to severity of cervical length shortening: a meta-analysis. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2010;35(4):468-73.
- 8. Berghella V, Odibo AO, To MS, Rust OA, Althuisius SM. Cerclage for short cervix on ultrasonography: meta-analysis of trials using individual patient-level data. Obstetrics and gynecology. 2005;106(1):181-9.
- 9. Ehsanipoor RM, Seligman NS, Saccone G, Szymanski LM, Wissinger C, Werner EF, et al. Physical Examination-Indicated Cerclage: A Systematic Review and Meta-analysis. Obstetrics and gynecology. 2015;126(1):125-35.
- 10. Paton MC, McDonald CA, Allison BJ, Fahey MC, Jenkin G, Miller SL. Perinatal brain injury as a consequence of preterm birth and intrauterine inflammation: designing targeted stem cell therapies. Frontiers in neuroscience. 2017;11:200.
- 11. Sciscione AC. Maternal activity restriction and the prevention of preterm birth. American journal of obstetrics and gynecology. 2010;202(3):232. e1-. e5.
- 12. Grobman WA, Gilbert SA, Iams JD, Spong CY, Saade G, Mercer BM, et al. Activity restriction among women with a short cervix. Obstetrics and gynecology. 2013;121(6):1181.
- 13. Berghella V, Rafael TJ, Szychowski JM, Rust OA, Owen J. Cerclage for short cervix on ultrasonography in women with singleton gestations and previous preterm birth: a meta-analysis. Obstetrics & Gynecology. 2011;117(3):663-71.
- 14. Chatzakis C, Efthymiou A, Sotiriadis A, Makrydimas G. Emergency cerclage in singleton pregnancies with painless cervical dilatation: A meta‐analysis. Acta Obstetricia et Gynecologica Scandinavica. 2020;99(11):1444-57.
- 15. Hashim HA, Al-Inany H, Kilani Z. A review of the contemporary evidence on rescue cervical cerclage. International Journal of Gynecology & Obstetrics. 2014;124(3):198-203.
- 16. Harger JH. Cerclage and cervical insufficiency: an evidence-based analysis. Obstetrics and gynecology. 2002;100(6):1313-27. 17. Chen Q, Chen G, Li N. Clinical effect of emergency cervical cerclage and elective cervical cerclage on pregnancy outcome in the cervical-incompetent pregnant women. Archives of gynecology and obstetrics. 2018;297(2):401-7.
- 18. Gluck O, Mizrachi Y, Ginath S, Bar J, Sagiv R. Obstetrical outcomes of emergency compared with elective cervical cerclage. The Journal of Maternal-Fetal & Neonatal Medicine. 2017;30(14):1650-4.
- 19. Wang S, Feng L. A single‐center retrospective study of pregnancy outcomes after emergency cerclage for cervical insufficiency. International Journal of Gynecology & Obstetrics. 2017;139(1):9-13.
- 20. Oh KJ, Romero R, Park JY, Lee J, Conde-Agudelo A, Hong J-S, et al. Evidence that antibiotic administration is effective in the treatment of a subset of patients with intra-amniotic infection/inflammation presenting with cervical insufficiency. American journal of obstetrics and gynecology. 2019;221(2):140. e1-. e18.
- 21. Mönckeberg M, Valdés R, Kusanovic JP, Schepeler M, Nien JK, Pertossi E, et al. Patients with acute cervical insufficiency without intra-amniotic infection/inflammation treated with cerclage have a good prognosis. Journal of perinatal medicine. 2019;47(5):500-9.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Kadın Hastalıkları ve Doğum |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Nisan 2021 |
| Gönderilme Tarihi | 4 Şubat 2021 |
| Kabul Tarihi | 16 Şubat 2021 |
| Yayımlandığı Sayı | Yıl 2021 Cilt: 18 Sayı: 1 |
