Erdem FADİLOĞLU
(Hacettepe Üniversitesi, Perinatoloji Anabilim Dalı Kadın Hastalıkları ve Doğum Anabilim Dalı, Ankara, Türkiye)
Canan
(Hacettepe Üniversitesi, Perinatoloji Anabilim Dalı Kadın Hastalıkları ve Doğum Anabilim Dalı , Ankara, Türkiye)
Yıl: 2021Cilt: 27Sayı: 1ISSN: 1300-4751 / 2602-4918Sayfa Aralığı: 40 - 43İngilizce

99 0
Evaluation and Management of Women who Have Experienced Stillbirth in Their Previous Pregnancies
OBJECTIVE: To evaluate the subsequent pregnancy outcomes of women who have experienced unexplained stillbirth in their previous gestations.STUDY DESIGN: This retrospective cohort consisted of 14 pregnancies who had stillbirth (withoutknown risk factors) in their previous pregnancies. These patients had been included in a special preconceptional care program to be evaluated in terms of etiological risk factors for stillbirth. At least oneof the risk factors, such as methylenetetrahydrofolate reductase polymorphisms, hereditary thrombophilias and autoimmune problems, were defined in this study population. After detection of pregnancy,the patients were administered low-dose low-molecular-weight heparin (enoxaparin, 1×2000 Anti-XAIU/0.2 mL/day), low-dose salicylic acid (100 mg/day) and low-dose corticosteroid (methylprednisolone,1×4 mg/day orally) in necessary cases.RESULTS: Out of 14 pregnancies, 4 (28.5%) ended up with miscarriages at 9, 11, 11 and 15 gestationalweeks, respectively. The remaining 10 pregnancies ended up with alive deliveries. The mean gestational week at birth was 36.4±0.51, while the mean birthweight was 2882±381.01 g. Out of 10 pregnancies, only one was diagnosed as IUGR. Only two newborn necessitated hospitalization in the neonatal intensive care unit due to respiratory problems. Both newborns were discharged from the neonatalintensive care unit without any further complication at the post-partum 5th day.CONCLUSION: Patients with a prior stillbirth should be screened for methylenetetrahydrofolate reductase polymorphisms, autoimmune problems and hereditary thrombophilias, especially in case of absence of any etiological factor. Management of these patients with low-dose aspirin, low-dose lowmolecular weight heparin and corticosteroids seemed to be beneficial for increasing live birth rates andavoiding obstetric complications.
DergiAraştırma MakalesiErişime Açık
  • 1. Joseph KS. Kinniburgh B. Hutcheon JA. Mehrabadi A. Dahlgren L. Basso M. et al. Rationalizing definitions and procedures for optimizing clinical care and public health in fetal death and stillbirth. Obstet Gynecol. 2015;125 (4):784-8. doi: 10.1097/AOG.0000000000000717.
  • 2. Organization WH. International statistical classification of diseases and related health problems: World Health Organization; 2004.
  • 3. Reddy UM. Management of pregnancy after stillbirth. Clin Obstet Gynecol. 2010;53(3):700-9. doi: 10.1097/ GRF.0b013e3181eba25e.
  • 4. Ecevit A. Oguz SS. Tarcan A. Yazici C. Dilmen U. The changing pattern of perinatal mortality and causes of death in central Anatolian region of Turkey. J Matern Fetal Neonatal Med. 2012;25(9):1738-41. doi:10.3109/ 14767058.2012.663820.
  • 5. Collaborators. GCM. Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1725-1774. doi: 10.1016/S0140- 6736(16)31575-6.
  • 6. Samueloff A. Xenakis E. Berkus M. Huff R. Langer O. Recurrent stillbirth. Significance and characteristics. J Reprod Med. 1993;38(11):883-6. PMID: 8277486.
  • 7. Surkan PJ. Stephansson O. Dickman PW. Cnattingius S. Previous preterm and small-for-gestational-age births and the subsequent risk of stillbirth. N Eng J Med. 2004;350 (8):777-85. doi: 10.1056/NEJMoa031587.
  • 8. Silver RM. Varner MW. Reddy U. Goldenberg R. Pinar H. Conway D. et al. Work-up of stillbirth: a review of the evidence. Am J Obsteta Gynecol. 2007;196(5):433-44. doi: 10.1016/j.ajog.2006.11.041.
  • 9. Group SCRNW. Causes of death among stillbirths. JAMA 2011;306(22):2459-68. doi: 10.1001/jama.2011.1823.
  • 10. Lockwood CJ. Heritable coagulopathies in pregnancy. Obstetric Gynecol Surv. 1999;54(12):754-65. doi:10. 1097/00006254-199912000-00004.
  • 11. Grønbæk L. Vilstrup H. Jepsen P. Pregnancy and birth outcomes in a Danish nationwide cohort of women with autoimmune hepatitis and matched population controls. Aliment Pharmacol Ther. 2018;48(6):655-663. doi: 10.1111/apt.14925.
  • 12. Kos BJP. Leemaqz SY. McCormack CD. Andraweera PH. Furness DL. Roberts CT. et al. The association of parental methylenetetrahydrofolate reductase polymorphisms (MTHFR 677C> T and 1298A> C) and fetal loss: a casecontrol study in South Australia. J Matern Fetal Neonatal Med. 2020;33(5):752-757. doi:10.1080/14767058.2018. 1500546.
  • 13. Gris JC. Mercier E. Quéré I. Lavigne-Lissalde G. Cochery-Nouvellon E. Hoffet M. et al. Low-molecularweight heparin versus low-dose aspirin in women with one fetal loss and a constitutional thrombophilic disorder. Blood. 2004;103(10):3695-9. doi: 10.1182/blood-2003- 12-4250.
  • 14. Heinonen S. Kirkinen P. Pregnancy outcome after previous stillbirth resulting from causes other than maternal conditions and fetal abnormalities. Birth. 2000;27(1):33- 7. doi: 10.1046/j.1523-536x.2000.00033.x.
  • 15. Robson SJ. Leader LR. Management of subsequent pregnancy after an unexplained stillbirth. J Perinatol. 2009; 30:305-10. doi: 10.1038/jp.2009.133.
  • 16. Robson S. Thompson J. Ellwood D. Obstetric management of the next pregnancy after an unexplained stillbirth: An anonymous postal survey of Australian obstetricians. Austr N Zealand J Obstet Gynaecol. 2006;46(4):278-81. doi: 10.1111/j.1479-828X.2006.00591.x.
  • 17. Hekimoglu R. Pergin A. Ugur Y, Beksac S. Turgal M. Cakar N. Impaired Implantation and Hereditary Thrombophila; Expression of LIF (Leukemia Inhibitory Factor) on Extravillous Trophoblasts. Gynecol Obstet Reprod Med. 2012;18(3):123-6.
  • 18. Molad Y. Borkowski T. Monselise A. Ben-Haroush A. Sulkes J. Hod M. et al. Maternal and fetal outcome of lupus pregnancy: a prospective study of 29 pregnancies. Lupus. 2005;14(2):145-51. doi: 10.1191/0961203305lu 2072oa.
  • 19. Beksac K. Orgul G. Cagan M., Karaagaoglu E. Arslan S. Beksac MS. Retrospective evaluation of pregnant women with celiac disease. J Turkish German Gynecol Assoc. 2017;18(1):56. doi: 10.4274/jtgga.2016.0198.
  • 20. Orgul G. Aktoz F. Beksac MS. Behcet’s disease and pregnancy: what to expect? J Obstet Gynaecol. 2018;38(2): 185-8. doi: 10.1080/01443615.2017.1336614.
  • 21. Beksac K. Orgul G. Can GS. Oktem A. Kav T. Beksac MS. Management of Inflammatory Bowel Disease and Pregnancy using Prophylactic Low Dose Low Molecular Weight Heparin and Corticosteroids. J Clin Diag Res. 2017;11(11). doi: 10.7860/JCR/2017/24683.10900.
  • 22. Turgal M. Gumruk F. Karaagaoglu E. Beksac MS. Methylenetetrahydrofolate reductase polymorphisms and pregnancy outcome. Geburtshilfe Frauenheilkd. 2018;78 (9):871-8. doi: 10.1055/a-0664-8237.
  • 23. Swain S. Singh S. The effect of low dose aspirin and low molecular weight heparin (enoxaparin) in recurrent pregnancy loss associated with antiphospholipid antibody syndrome. Int J Reprod Contracept Obstet Gynecol. 2017;6 (11):5. doi: 10.18203/2320-1770.ijrcog20174652.
  • 24. Monari F. Pedrielli G. Vergani P. Pozzi E. Mecacci F. Serena C. et al. Adverse Perinatal Outcome in Subsequent Pregnancy after Stillbirth by Placental Vascular Disorders. PLoS One. 2016;11(5):e0155761. doi: 10.1371/journal.pone.0155761.

TÜBİTAK ULAKBİM Ulusal Akademik Ağ ve Bilgi Merkezi Cahit Arf Bilgi Merkezi © 2019 Tüm Hakları Saklıdır.