Öz
Aim: Early diagnosis of trisomies occupies an important place in the working life of perinatologists and obstetricians. Early diagnosis of this condition is very important in raising a healthy generation. Early diagnosis informs decisions such as mental and physical preparation after birth or termination of pregnancy. Early detection of this risk is ensured by testing fetal nuchal translucency (NT), free human chorionic gonadotropin-β (free-βhCG) and pregnancy-related plasma protein-A (PAPP-A) levels at appropriate intervals. Also, with the help of these tests, perinatal risks such as chromosomal abnormalities, intrauterine growth retardation (IUGR) and preterm birth can be detected, and precautionary measures can be taken. In this study, we are trying to find out if it is possible to predict IUGR using these tests in the first trimester and evaluating the infants born here. Perhaps retrospective evaluation of these tests can be used to prevent poor pregnancy outcomes or, if necessary, to reduce the incidence of complications by delivering babies in more appropriate centers.
Method: One of the hospitals included in this study is a training and research hospital and the other is a state hospital with active birth management, where the number of births is higher than the regional average. This study was conducted using data obtained by pediatrics and obstetrics by scanning the records of patients who had gone to their centers for postnatal care and the babies who were born. The population that served as the control group was reached in the same way. The period for the study was limited to two years.
Results: 257 patients who had enrolled in centers for prenatal care over two years were included in the study. While 132 healthy pregnant women participated in the study as a control group, 125 pregnant women diagnosed with IUGR were included in the study. When the screening tests were compared in the first trimester, the mean PAPP-A level was higher in the control group than in the patient group (p=0.006). Free β-hCG was also higher in the control group (p=0.024). The result after performing the necessary statistical adjustments PAPP-A showed the statistical significance of its value in the analysis. However, the same tests did not show the same success in the IUGR group and were not statistically successful in predicting poor neonatal outcomes.
Conclusion: In this study, the use of PAPP-A level in the first trimester has been shown to provide successful results in estimating IUGR that may occur later in pregnancy. However, no parameter has shown the same predictive success in predicting poor neonatal outcomes.
Anahtar Kelimeler
Intrauterine growth retardation first-trimester screening PAPP-A
Teşekkür
Special thanks to Kahraman Kılavuz for proofreading. (kahramankilavuz@sdu.edu.tr) (https://orcid.org/0000-0002-6625-4105 )
Kaynakça
- 1. Mohammed O, Magdy A, Askalany A, et al. Role of maternal uterine artery doppler versus serum β-hCG during the first trimester in the prediction of preeclampsia and IUGR. Journal of Diagnostic Medical Sonography. 2022;38(2):111-118.
- 2. Hamed Abdelaziz ME, Farhan AAM, Elboghdady AA. First-trimester uterine artery doppler indices in the prediction of small-for-gestational age pregnancy and intrauterine growth restriction in low risk population. Al-Azhar International Medical Journal. 2022;3(4):97-101.
- 3. Capriglione S, Gulino FA, Latella S, et al. Results of a five-year experience in first trimester preeclampsia screening. Journal of Clinical Medicine. 2022;11(15):4555.
- 4. Morales-Prieto DM, Fuentes-Zacarías P, Murrieta-Coxca JM, et al. Smoking for two-effects of tobacco consumption on placenta. Molecular Aspects of Medicine. 2021;87:101023.
- 5. Honarjoo M, Zarean E, Tarrahi MJ, Kohan S. Role of pregnancy-associated plasma protein A (PAPP-A) and human-derived chorionic gonadotrophic hormone (free β-hCG) serum levels as a marker in predicting of small for gestational age (SGA): A cohort study. Journal of Research in Medical Sciences: The Official Journal of Isfahan University of Medical Sciences. 2021;26(1):104.
- 6. Mirsafaie M, Moghaddam-Banaem L, Kheirollahi M. The relationship between screening markers in the first trimester of pregnancy and chromosome aberrations. International Journal of Preventive Medicine. 2022;13(1):81.
- 7. Kapustin RV, Kascheeva TK, Alekseenkova EN, Shelaeva EV. Are the first-trimester levels of PAPP-A and fb-hCG predictors for obstetrical complications in diabetic pregnancy? The Journal of Maternal-Fetal & Neonatal Medicine. 2022;35(6):1113-1119.
- 8. Zavlanos A, Tsakiridis I, Chatzikalogiannis I, Athanasiadis A. Early-and late-onset intrauterine growth retardation. Donald School Journal of Ultrasound in Obstetrics and Gynecology. 2021;15(1):97-108.
- 9. Chen Y, Ning W, Chu X, et al. Predicting hypertensive disease in the first trimester of pregnancy: Risk models and analysis of serum D-dimer levels combined with plasma pregnancy-associated protein A, free β-subunit of human chorionic gonadotropin, and fetal nuchal translucency. BioMed Research International. 2022;2022.
- 10. Ozdemir S, Sahin O, Acar Z, Demir GZ, Ermin E, Aydin A. Prediction of pregnancy complications with maternal biochemical markers used in down syndrome screening. Cureus. 2022;14(3).
- 11. Feng Y, Zheng H, Fang D, Mei S, Zhong W, Zhang G. Prediction of late-onset fetal growth restriction using a combined first-and second-trimester screening model. Journal of Gynecology Obstetrics and Human Reproduction. 2022;51(2):102273.
- 12. Chen CP, Lan FH, Chern SR, et al. Prenatal diagnosis of mosaic trisomy 16 by amniocentesis in a pregnancy associated with abnormal first-trimester screening result (low PAPP-A and low PlGF), intrauterine growth restriction and a favorable outcome. Taiwanese Journal of Obstetrics and Gynecology. 2021;60(6):1107-1111.
- 13. Sharmila C, Saraswathi K. Efficiency of first trimester uterine artery doppler and serum papp-a in the prediction of pre eclampsia in 300 antenatal patients. Annals of the Romanian Society for Cell Biology. 2021:3460-3470.
- 14. Genc S, Ozer H, Emeklioglu CN, et al. Relationship between extreme values of first trimester maternal pregnancy associated plasma protein-A, free-β-human chorionic gonadotropin, nuchal translucency and adverse pregnancy outcomes. Taiwanese Journal of Obstetrics and Gynecology. 2022;61(3):433-440.
Öz
Amaç: Trizomilerin erken teşhisi perinatolog ve kadın doğum uzmanlarının çalışma hayatında önemli bir yer tutmaktadır. Bu durumun erken teşhisi sağlıklı bir nesil yetiştirmek için çok önemlidir. Erken teşhis, doğumdan sonra veya hamileliğin sonlandırılmasından sonra zihinsel ve fiziksel hazırlık gibi kararlar hakkında bilgi verir. Bu riskin erken tespiti, fetal ense saydamlığı (NT), serbest insan koryonikgonadotropin-β (serbest-βhCG) ve gebelikle ilişkili plazma protein-A (PAPP-A) düzeylerinin uygun aralıklarla test edilmesiyle sağlanır. Ayrıca bu testler yardımıyla kromozom anomalileri, intrauterin gelişme geriliği (IUGR) ve erken doğum gibi perinatal riskler tespit edilerek önlem alınabilir. Bu çalışmada ilk trimesterde bu testleri kullanarak ve burada doğan bebekleri değerlendirerek IUGR'yi tahmin etmenin mümkün olup olmadığını bulmaya çalışılmıştır. Bu testlerin geriye dönük değerlendirilmesi, kötü gebelik sonuçlarını önlemek veya gerekirse bebekleri daha uygun merkezlerde doğumlarının sağlanması komplikasyon insidansını azaltmak için kullanılabilir.
Yöntem: Çalışmaya dahil edilen hastanelerden biri eğitim ve araştırma hastanesi diğeri ise aktif doğum yönetimine sahip bir devlet hastanesi olup, doğum sayısı bölge ortalamasının üzerindedir. Bu çalışma, gebelik takibi için merkezlere başvuran hasta ve onlardan doğan bebeklerin kayıtları taranarak pediatri ve kadın doğum hekimleri elde edilen verilerle yapılmıştır. Kontrol grubu olarak oluşturulan hasta grubuna da aynı şekilde ulaşılmıştır. Araştırma süresi iki yıl ile sınırlandırılmıştır.
Bulgular: Çalışmaya iki yıl boyunca doğum öncesi bakım için merkezlerimize başvuran 257 hasta dahil edildi. Çalışmaya 132 sağlıklı gebe kontrol grubu olarak katılırken, IUGR tanısı almış 125 gebe çalışmaya dahil edildi. Birinci trimester tarama testleri karşılaştırıldığında, kontrol grubunda ortalama PAPP-A düzeyi hasta grubuna göre daha yüksekti (p=0,006). Serbest β-hCG de kontrol grubunda daha yüksekti (p=0,024). PAPP-A gerekli istatistiksel ayarlamaları yaptıktan sonra elde edilen sonuç, analizdeki değerinin istatistiksel olarak anlamlı olduğunu gösterdi. Ancak aynı testler IUGR grubunda aynı başarıyı göstermedi ve kötü yenidoğan sonuçlarını öngörmede istatistiksel olarak başarılı olmadı.
Sonuç: Çalışmada ilk trimesterde PAPP-A seviyesinin kullanılmasının, daha sonraki gebeliklerde ortaya çıkabilecek IUGR'yi tahmin etmede başarılı sonuçlar sağladığı gösterilmiştir. Bununla birlikte, hiçbir parametre, kötü yenidoğan sonuçlarını öngörmede aynı öngörücü başarıyı göstermedi.
Anahtar Kelimeler
Kaynakça
- 1. Mohammed O, Magdy A, Askalany A, et al. Role of maternal uterine artery doppler versus serum β-hCG during the first trimester in the prediction of preeclampsia and IUGR. Journal of Diagnostic Medical Sonography. 2022;38(2):111-118.
- 2. Hamed Abdelaziz ME, Farhan AAM, Elboghdady AA. First-trimester uterine artery doppler indices in the prediction of small-for-gestational age pregnancy and intrauterine growth restriction in low risk population. Al-Azhar International Medical Journal. 2022;3(4):97-101.
- 3. Capriglione S, Gulino FA, Latella S, et al. Results of a five-year experience in first trimester preeclampsia screening. Journal of Clinical Medicine. 2022;11(15):4555.
- 4. Morales-Prieto DM, Fuentes-Zacarías P, Murrieta-Coxca JM, et al. Smoking for two-effects of tobacco consumption on placenta. Molecular Aspects of Medicine. 2021;87:101023.
- 5. Honarjoo M, Zarean E, Tarrahi MJ, Kohan S. Role of pregnancy-associated plasma protein A (PAPP-A) and human-derived chorionic gonadotrophic hormone (free β-hCG) serum levels as a marker in predicting of small for gestational age (SGA): A cohort study. Journal of Research in Medical Sciences: The Official Journal of Isfahan University of Medical Sciences. 2021;26(1):104.
- 6. Mirsafaie M, Moghaddam-Banaem L, Kheirollahi M. The relationship between screening markers in the first trimester of pregnancy and chromosome aberrations. International Journal of Preventive Medicine. 2022;13(1):81.
- 7. Kapustin RV, Kascheeva TK, Alekseenkova EN, Shelaeva EV. Are the first-trimester levels of PAPP-A and fb-hCG predictors for obstetrical complications in diabetic pregnancy? The Journal of Maternal-Fetal & Neonatal Medicine. 2022;35(6):1113-1119.
- 8. Zavlanos A, Tsakiridis I, Chatzikalogiannis I, Athanasiadis A. Early-and late-onset intrauterine growth retardation. Donald School Journal of Ultrasound in Obstetrics and Gynecology. 2021;15(1):97-108.
- 9. Chen Y, Ning W, Chu X, et al. Predicting hypertensive disease in the first trimester of pregnancy: Risk models and analysis of serum D-dimer levels combined with plasma pregnancy-associated protein A, free β-subunit of human chorionic gonadotropin, and fetal nuchal translucency. BioMed Research International. 2022;2022.
- 10. Ozdemir S, Sahin O, Acar Z, Demir GZ, Ermin E, Aydin A. Prediction of pregnancy complications with maternal biochemical markers used in down syndrome screening. Cureus. 2022;14(3).
- 11. Feng Y, Zheng H, Fang D, Mei S, Zhong W, Zhang G. Prediction of late-onset fetal growth restriction using a combined first-and second-trimester screening model. Journal of Gynecology Obstetrics and Human Reproduction. 2022;51(2):102273.
- 12. Chen CP, Lan FH, Chern SR, et al. Prenatal diagnosis of mosaic trisomy 16 by amniocentesis in a pregnancy associated with abnormal first-trimester screening result (low PAPP-A and low PlGF), intrauterine growth restriction and a favorable outcome. Taiwanese Journal of Obstetrics and Gynecology. 2021;60(6):1107-1111.
- 13. Sharmila C, Saraswathi K. Efficiency of first trimester uterine artery doppler and serum papp-a in the prediction of pre eclampsia in 300 antenatal patients. Annals of the Romanian Society for Cell Biology. 2021:3460-3470.
- 14. Genc S, Ozer H, Emeklioglu CN, et al. Relationship between extreme values of first trimester maternal pregnancy associated plasma protein-A, free-β-human chorionic gonadotropin, nuchal translucency and adverse pregnancy outcomes. Taiwanese Journal of Obstetrics and Gynecology. 2022;61(3):433-440.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Makaleler |
| Yazarlar | |
| Erken Görünüm Tarihi | 27 Nisan 2024 |
| Yayımlanma Tarihi | 30 Nisan 2024 |
| Kabul Tarihi | 13 Mart 2024 |
| Yayımlandığı Sayı | Yıl 2024 Sayı: 22 |
Alıntı-Gayriticari-Türetilemez 4.0 Uluslararası (CC BY-NC-ND 4.0)