Publication: Maternal vücut kitle indeksi ile 11-14 hafta arası gebelerde yapılan duktus venozus doppler incelemesi arasında ilişki olup olmadığının saptanması
Abstract
Amaç: Duktus venozus iyi oksijenlenmiş kanın plasentadan fetal kalbe taşınmasını sağlayan ince bir damarsal yapıdır. Duktus venozus akım paternindeki bozukluklar ile maternal hiperglisemi, maternal kronik hastalıklar, fetal hastalıklar, fetal anöploidi arasında ilişki olabileceği birçok çalışmada gösterilmiştir. Biz de bu çalışmamızda maternal kilo ile duktus venozus kan akım paterni arasında ilişki olup olmadığını incelemeyi planladık. Gereç ve yöntem: Marmara Üniversitesi Tıp Fakültesi Hastanesi Kadın hastalıkları ve Doğum gebe polikliniğine başvuran 11-14 hafta arası, vücut kitle indeksi<25 olan 83 gebe ve vücut kitle indeksi≥25 olan 123 gebe çalışmaya dahil edilmiştir. Gebelerin vücut kitle indeksleri kilonun, boyun metre cinsinden karesine bölünmesi ile hesaplandı. Gebelerin demografik özellikleri, antenatal tarama testleri, Duktus venozus kan akım paternleri kayıt edildi. Duktus venozus akım paterninde a dalgasının kaybı veya ters a dalgası görülmesi akım paterninde bozulma olarak tanımlandı. Bulgular: Her iki grup arasında kombine test, üçlü test, 2.Düzey ultrasonografi sonuçları açısından istatiksel anlamlı bir farklılık saptanmamıştır. Çalışmaya alınan gebelerin %12’sinde DV’da a dalgası kaybı ve/ veya ters a dalgası izlenmiştir. Geri kalan gebelerde ise a dalgası patolojisi izlenmemiştir. Çalışmaya alınan gebelerden VKİ 25 altında olanların %4.8’inde duktus venozus akım paterninde anormallik bulunurken, VKİ≥25 olan gebelerin %17’sinde duktus venozus akım paterninde bozulma izlenmiştir ve istatistiksel olarak bu fark anlamlıdır (p=0,008). Sonuç: Maternal obezitenin gebelikte olumsuz fetal ve maternal sonuçlarla ilişkili olabileceği birçok çalışmada gösterilmiştir. Bunların arasında fetal anomaliler, intrauterin gelişim problemleri, maternal hastalıklar yeralmaktadır. İlk trimesterde duktus venozus kan akım paterninde bozulmanın fetal kardiyak problemler, fetal anöploidi ile ilişkili olabileceği bilinmektedir. 1. trimester prenatal taraması normal olup tek anomal bulgusu duktus venozus akım paterninde bozulma olan fetüslerde maternal hipergliseminin ve vücut kitle indeksinin bunda rol oynayabileceği düşüncesindeyiz.
Aim: Ductus venosus is a fine vascular structure providing oxygenated blood from placenta to fetal heart. Many studies showed association between ductus venosus flow disturbances and maternal hyperglycemia, maternal chronic diseases, fetal diseases, and fetal aneuploidism. In this study, we aimed to investigate the possible causative relationship between maternal obesity and flow patterns of ductus venosus. Material-method: 123 pregnant women with body mass index of 25 or higher and 83 pregnant women with body mass index lower than 25 in gestational weeks between 11-14, who were admitted to Marmara University School of Medicine, Department of Obstetrics and Gynecology outpatient clinic were included in the current study. The body mass index of the patients were calculated by dividing the weights in kilograms by the heights in meter square. The demographics, antenatal scanning test results, ductus venosus flow patterns were recorded. Loss of a wave or inverse a waves were identified as flow pattern disturbances. Results: There were no statistically significant difference between two groups for combined test, three component antenatal test, second level ultrasonography. In 12% of the women loss of a wave and/ or inverse a wave was noted. In the rest of the women there were no pathological a waves. In 4.8% of women with a BMI less than 25 there was abnormality in ductus venosus flow pattern, whereas this ratio was 17% in the other group consisted of women with BMI higher than 25; and the difference was statistically significant (p=0.008). Discussion: Many studies showed adverse effects of maternal obesity on fetal and maternal health. These can be fetal abnormalities, intrauterine growth retardation, and maternal diseases. It is well known that abnormal flow patterns in ductus venosus during the first trimester is associated with fetal cardiac problems and aneuploidism. We conclude that maternal hyperglycemia and high body mass index may cause abnormal flow paterns in ductus venosus in pregnancies with normal first trimester scanning and abnormal flow patterns of ductus venosus.
Aim: Ductus venosus is a fine vascular structure providing oxygenated blood from placenta to fetal heart. Many studies showed association between ductus venosus flow disturbances and maternal hyperglycemia, maternal chronic diseases, fetal diseases, and fetal aneuploidism. In this study, we aimed to investigate the possible causative relationship between maternal obesity and flow patterns of ductus venosus. Material-method: 123 pregnant women with body mass index of 25 or higher and 83 pregnant women with body mass index lower than 25 in gestational weeks between 11-14, who were admitted to Marmara University School of Medicine, Department of Obstetrics and Gynecology outpatient clinic were included in the current study. The body mass index of the patients were calculated by dividing the weights in kilograms by the heights in meter square. The demographics, antenatal scanning test results, ductus venosus flow patterns were recorded. Loss of a wave or inverse a waves were identified as flow pattern disturbances. Results: There were no statistically significant difference between two groups for combined test, three component antenatal test, second level ultrasonography. In 12% of the women loss of a wave and/ or inverse a wave was noted. In the rest of the women there were no pathological a waves. In 4.8% of women with a BMI less than 25 there was abnormality in ductus venosus flow pattern, whereas this ratio was 17% in the other group consisted of women with BMI higher than 25; and the difference was statistically significant (p=0.008). Discussion: Many studies showed adverse effects of maternal obesity on fetal and maternal health. These can be fetal abnormalities, intrauterine growth retardation, and maternal diseases. It is well known that abnormal flow patterns in ductus venosus during the first trimester is associated with fetal cardiac problems and aneuploidism. We conclude that maternal hyperglycemia and high body mass index may cause abnormal flow paterns in ductus venosus in pregnancies with normal first trimester scanning and abnormal flow patterns of ductus venosus.