Yıl: 2021 Cilt: 22 Sayı: 2 Sayfa Aralığı: 149 - 154 Metin Dili: İngilizce DOI: 10.4274/imj.galenos.2021.56823 İndeks Tarihi: 06-11-2021

Changing Trends over the Years in Pregnancy Termination due to Fetal Anomalies

Öz:
Introduction: To examine the indications for termination dueto fetal anomalies performed in our clinic between January2015 and October 2020 and to determine the differencesbetween years.Methods: This study is a retrospective, observational studyinvolving 385 patients who underwent termination beforethe 24th week due to fetal anomalies at Karadeniz TechnicalUniversity, Farabi Hospital, Clinic of Perinatology. Terminationdata were analyzed by dividing the sample into two groups:terminations performed between 11 and 14 weeks (firsttrimester) and those between 15 and 24 weeks (secondtrimester) of gestation.Results: Structural malformations constituted 81.3% oftermination of pregnancy (TOP) cases, chromosomalanomalies 14.5%, and genetic diseases 4.2%. Central nervoussystem (CNS) anomalies, at 43.4%, were the most commoncause of termination. Aneuploidy was present in 56 (34.8%)of 161 cases for which karyotype analysis was available. Thenumber of terminations that took place in both the first andthe second trimesters was the highest in 2019. A continuousincrease was observed in the number of terminations overthe years evaluated. When the systems were evaluatedindividually, it was observed that the number of cases in thesecond trimester with CNS and face and neck anomalies wasstatistically significantly higher than that in the first trimester(p=0.002, p=0.037, respectively). In all, 28.3% of terminationswere performed in the first trimester and 71.7% in the secondtrimester.Conclusion: When the distribution of TOP indications over theyears was examined, it was observed that the number of casesrelated to chromosomal anomalies, cardiovascular systemanomalies, and genetic diseases had increased gradually.
Anahtar Kelime:

Fetal Anomalilere Bağlı Gebelik Terminasyonunda Yıllar İçerisinde Değişen Eğilimler

Öz:
Amaç: Kliniğimizde Ocak 2015-Ekim 2020 yılları arasında yapılan fetal anomalilere bağlı gebelik terminasyonlarının endikasyonlarını incelemek ve yıllar arasındaki farklılıkları belirlemektir. Yöntemler: Çalışmamız, Karadeniz Teknik Üniversitesi, Farabi Hastanesi, Perinatoloji Kliniği’nde, fetal anomaliler sebebiyle 24. gebelik haftasından önce terminasyon uygulanan 385 olguyu içeren retrospektif bir çalışmadır. Terminasyon verileri, 11-14 hafta (1. trimester) arası olgular ve 15-24 hafta (2. trimester) arası olgular olarak iki gruba ayrılarak analiz edilmiştir. Bulgular: Terminasyon olgularının %81,3’ünü yapısal malformasyonlar, %14,5’ini kromozom anomalileri ve %4,2’sini genetik hastalıklar oluşturmaktaydı. %43,4 ile santral sinir sistemi (SSS) anomalileri, terminasyonların en sık nedeniydi. Karyotip analizi yapılan 161 olgunun 56’sında (%34,8) anöploidi mevcuttu. Hem 1. trimesterde hem de 2. trimesterde gerçekleşen terminasyon sayıları, 2019 yılında en yüksekti. Değerlendirilen yıllar içerisinde terminasyon sayılarında devamlı bir artış olduğu görüldü. Sistemler ayrı ayrı değerlendirildiğinde, SSS ve yüz ve boyun anomalileri açısından 2. trimesterdeki olguların 1. trimesterdeki olgulara göre istatistiksel olarak anlamlı derecede yüksek olduğu görüldü (sırasıyla; p=0,002, p=0,037). Olguların %28,3’ü 1. trimesterde, %71,7’si 2. trimesterde termine edilmişti. Sonuç: Terminasyon olgularının yıllar içindeki dağılımı incelendiğinde; kromozom anomalileri, kardiyovasküler sistem anomalileri ve genetik hastalıklara bağlı olguların sayısının giderek arttığı görülmektedir.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 1. Resmigazete. 2827 sayılı nufus planlaması hakkındaki kanun. Tertip: 1983; 22: 352 2827 (18059).
  • 2. Gursoy A. Abortion in Turkey: a matter of state, family or individual decision. Soc Sci Med 1996; 42: 531-42.
  • 3. Levy B, Stosic M. Traditional Prenatal Diagnosis: Past to Present. Methods Mol Biol 2019; 1885: 3-22.
  • 4. ACOG Practice Bulletin No. 135: Second-trimester abortion. Obstet Gynecol 2013; 121: 1394-406.
  • 5. Best practice in comprehensive abortion care. (Best Practice Paper No 2.) RCOG 2015.
  • 6. Hamida EB, Ayadi I, Bezzine A, Rabii B, Hammouda SB, Bouguerra B, et al. Termination of pregnancy for fetal anomaly in a Tunisian population. S Afr J Obstet Gynaecol 2017; 23: 69-70.
  • 7. Feldman N, Melcer Y, Hod E, Levinsohn-Tavor O, Svirsky R, Maymon R. Termination of pregnancy due to fetal abnormalities performed after 32 weeks’ gestation: survey of 57 fetuses from a single medical center. J Matern Fetal Neonatal Med 2018; 31: 740-6.
  • 8. Beksaç MS. Doğum Hekimliği Meternal-Fetal Tıp’ta Etik ve Yasal Boyut. Ankara, Mebas Medikal Basın Yayın Ltd. Şti 2006.
  • 9. Uyumaz A, Avcı Y. Termination of Pregnancy in Turkish Law. J Fac L Inonu U 2016; 7: 579-638.
  • 10. Özgül G, Soyak B, Aydın E, Tanaçan A, Çağan M, Beksaç MS. 22 Pregnancies Ending Before The 22nd Week of Gestation. J Gynecol Obstet Neonatal 2017; 14: 66-9.
  • 11. Dar P, Shani H, Evans MI. Cell-free DNA: Comparison of Technologies. Clin Lab Med 2016; 36: 199-211.
  • 12. Barel O, Vaknin Z, Smorgick N, Reish O, Mendlovic S, Herman A, et al. Fetal abnormalities leading to third trimester abortion: nine-year experience from a single medical center. Prenat Diagn 2009; 29: 223-8.
  • 13. Corbacıoğlu A, Aslan H, Aydın S, Akbayır O, Ersan F, Alpay V, et al. Trends in fetal indications for termination of pregnancy between 2002 and 2010 at a tertiary referral centre. J Turk Ger Gynecol Assoc 2012; 13: 85-90.
  • 14. Hern WM. Fetal diagnostic indications for second and third trimester outpatient pregnancy termination. Prenat Diagn 2014; 34: 438-44.
  • 15. Syngelaki A, Hammami A, Bower S, Zidere V, Akolekar R, Nicolaides KH. Diagnosis of fetal non-chromosomal abnormalities on routine ultrasound examination at 11-13weeks’ gestation. Ultrasound Obstet Gynecol 2019; 54: 468-76.
  • 16. Carlson LM, Vora NL. Prenatal Diagnosis: Screening and Diagnostic Tools. Obstet Gynecol Clin North Am 2017; 44: 245-56.
  • 17. Cuckle H, Maymon R. Development of prenatal screening--A historical overview. Semin Perinatol 2016; 40: 12-22.
  • 18. Dommergues M, Mandelbrot L, Mahieu-Caputo D, Boudjema N, DurandZaleski I; ICI Group-Club de médecine foetale. Termination of pregnancy following prenatal diagnosis in France: how severe are the foetal anomalies? Prenat Diagn 2010; 30: 531-9.
  • 19. Wyldes MP, Tonks AM. Termination of pregnancy for fetal anomaly: a population-based study 1995 to 2004. BJOG 2007; 114: 639-42.
  • 20. Cordier AG, Thubert T, Dussaux C, Santulli P, Dommergues M, Picone O, et al. Evolution of third-trimester pregnancy terminations in France. Eur J Obstet Gynecol Reprod Biol 2020; 248: 123-7.
  • 21. Minnella GP, Crupano FM, Syngelaki A, Zidere V, Akolekar R, Nicolaides KH. Diagnosis of major heart defects by routine first-trimester ultrasound examination: association with increased nuchal translucency, tricuspid regurgitation and abnormal flow in ductus venosus. Ultrasound Obstet Gynecol 2020; 55: 637-44.
  • 22. Ozyuncu O, Orgul G, Tanacan A, Aktoz F, Guleray N, Fadiloglu E, et al. Retrospective analysis of indications for termination of pregnancy. J Obstet Gynaecol 2019; 39: 355-8.
  • 23. Garofalo G, Garofalo A, Sochirca O, Alemanno MG, Pilloni E, Biolcati M, et al. Maternal outcomes in first and second trimester termination of pregnancy: which are the risk factors? J Perinat Med 2018; 46: 373-8.
APA özalp m, şal h, koç e, akbaş h, Demir O, Aran T, Osmanağaoğlu M (2021). Changing Trends over the Years in Pregnancy Termination due to Fetal Anomalies. , 149 - 154. 10.4274/imj.galenos.2021.56823
Chicago özalp miraç,şal hidayet,koç emine ahu,akbaş hümeyra,Demir Omer,Aran Turhan,Osmanağaoğlu Mehmet Armağan Changing Trends over the Years in Pregnancy Termination due to Fetal Anomalies. (2021): 149 - 154. 10.4274/imj.galenos.2021.56823
MLA özalp miraç,şal hidayet,koç emine ahu,akbaş hümeyra,Demir Omer,Aran Turhan,Osmanağaoğlu Mehmet Armağan Changing Trends over the Years in Pregnancy Termination due to Fetal Anomalies. , 2021, ss.149 - 154. 10.4274/imj.galenos.2021.56823
AMA özalp m,şal h,koç e,akbaş h,Demir O,Aran T,Osmanağaoğlu M Changing Trends over the Years in Pregnancy Termination due to Fetal Anomalies. . 2021; 149 - 154. 10.4274/imj.galenos.2021.56823
Vancouver özalp m,şal h,koç e,akbaş h,Demir O,Aran T,Osmanağaoğlu M Changing Trends over the Years in Pregnancy Termination due to Fetal Anomalies. . 2021; 149 - 154. 10.4274/imj.galenos.2021.56823
IEEE özalp m,şal h,koç e,akbaş h,Demir O,Aran T,Osmanağaoğlu M "Changing Trends over the Years in Pregnancy Termination due to Fetal Anomalies." , ss.149 - 154, 2021. 10.4274/imj.galenos.2021.56823
ISNAD özalp, miraç vd. "Changing Trends over the Years in Pregnancy Termination due to Fetal Anomalies". (2021), 149-154. https://doi.org/10.4274/imj.galenos.2021.56823
APA özalp m, şal h, koç e, akbaş h, Demir O, Aran T, Osmanağaoğlu M (2021). Changing Trends over the Years in Pregnancy Termination due to Fetal Anomalies. İstanbul Medical Journal, 22(2), 149 - 154. 10.4274/imj.galenos.2021.56823
Chicago özalp miraç,şal hidayet,koç emine ahu,akbaş hümeyra,Demir Omer,Aran Turhan,Osmanağaoğlu Mehmet Armağan Changing Trends over the Years in Pregnancy Termination due to Fetal Anomalies. İstanbul Medical Journal 22, no.2 (2021): 149 - 154. 10.4274/imj.galenos.2021.56823
MLA özalp miraç,şal hidayet,koç emine ahu,akbaş hümeyra,Demir Omer,Aran Turhan,Osmanağaoğlu Mehmet Armağan Changing Trends over the Years in Pregnancy Termination due to Fetal Anomalies. İstanbul Medical Journal, vol.22, no.2, 2021, ss.149 - 154. 10.4274/imj.galenos.2021.56823
AMA özalp m,şal h,koç e,akbaş h,Demir O,Aran T,Osmanağaoğlu M Changing Trends over the Years in Pregnancy Termination due to Fetal Anomalies. İstanbul Medical Journal. 2021; 22(2): 149 - 154. 10.4274/imj.galenos.2021.56823
Vancouver özalp m,şal h,koç e,akbaş h,Demir O,Aran T,Osmanağaoğlu M Changing Trends over the Years in Pregnancy Termination due to Fetal Anomalies. İstanbul Medical Journal. 2021; 22(2): 149 - 154. 10.4274/imj.galenos.2021.56823
IEEE özalp m,şal h,koç e,akbaş h,Demir O,Aran T,Osmanağaoğlu M "Changing Trends over the Years in Pregnancy Termination due to Fetal Anomalies." İstanbul Medical Journal, 22, ss.149 - 154, 2021. 10.4274/imj.galenos.2021.56823
ISNAD özalp, miraç vd. "Changing Trends over the Years in Pregnancy Termination due to Fetal Anomalies". İstanbul Medical Journal 22/2 (2021), 149-154. https://doi.org/10.4274/imj.galenos.2021.56823