Tekil gebeliklerin 11–13 hafta incelemesinde posterior fossada intrakraniyal saydamlık görüntüsünün elde edilememesi: Nedenler ve sonuçlar

Failure of getting intracranial translucency image in posterior fossa in the examination of singleton pregnancies at 11–13 weeks of gestation: reasons and outcomes

Özet

Amaç: ‹ntrakraniyal saydaml›k (IT) görülememesinin neden ve sonuçlar›n› araflt›rmak, IT negatifli¤ini takip edebilen olumsuzluklardaki duyarl›l›¤›, özgüllü¤ü, pozitif ve negatif belirleyicilikleri ve tan›sal do¤ruluk oran›m›z› belirlemek. Yöntem: Bu çal›flma 2670 tekil gebeli¤in verilerinin retrospektif de¤erlendirilmesi olarak tasarland›. Serebral yap›lar ve posterior fossa incelemesi klasik ense kal›nl›¤› inceleme plan›nda gerçeklefltirildi ve IT’nin görülemedi¤i veya ölçülemedi¤i olgular çal›flma grubunu oluflturdu. Bu olgulardaki maternal özelliklerin yan› s›ra gebelik prognozuna etki edebilecek kromozom anomalileri, malformasyonlar ve fetüs kay›plar›n›n da¤›l›m› incelenerek normal olarak kabul edilen grup ile karfl›laflt›r›ld›. Bulgular: Posterior fossada IT ölçülemeyen olgu oran› %4.05 idi. IT ölçülebilmifl grup ile karfl›laflt›r›ld›¤›nda IT ölçülememifl olan grupta kötü gebelik prognozu, fetüs kayb› veya gebelik sonland›rma ifllemi, erken döneme ait kromozomopati belirteçleri ile kromozom anomali varl›¤›, merkezi sinir sistemi ve di¤er sistem malformasyonlar›n›n oran› istatistiksel olarak anlaml› flekilde daha yüksek saptand›. IT görülememesinin yukar›da say›lan kötü gebelik prognozunu tahmin etmedeki duyarl›l›¤› %26.9, özgüllük %95.9, pozitif belirleyicili¤i %21.9, negatif belirleyicili¤i %96.9, do¤ruluk oran› %93, olas›l›k oran› 8.7 olarak saptand›. Sonuç: Çal›flmam›zda elde etti¤imiz bulgular, intrakraniyal saydaml›¤›n merkezi sinir sistemi ve di¤er sistem malformasyonlar› ile baz› kromozom anomalilerinin erken tan›s›nda klasik yöntemlere yard›mc› bir parametre olarak yer alabilece¤ini ve rutin perinatal incelemenin içinde kullan›lmas›n›n faydal› olabilece¤ini düflündürmektedir.

Abstract

Objective: To investigate the reasons and outcomes of being unable to see intracranial translucency (IT), and to determine the sensitivity, specificity, positive and negative predictive values and our diagnostic accuracy rate for the poor outcomes that may follow IT negativity. Methods: This study was designed as the retrospective assessment of the data of 2670 singleton pregnancies. The evaluation of cerebral structures and posterior fossa was conducted on classical nuchal translucency evaluation plane and the cases, IT of whose could not be seen or measured, were included in the study. The distribution of chromosomal anomalies, malformations and fetal losses which may affect gestational prognosis as well as maternal characteristics of these cases was evaluated and they were compared with the group considered normal. Results: The rate of the cases whose IT could not be measured in posterior fossa was 4.05%. Compared to the group whose IT could be measured, poor prognosis of gestation, fetal loss or termination of pregnancy, chromosomopathy markers of early period and the presence of chromosomal anomaly, and the rate of central nervous system and other system malformations were higher in a statistically significant manner in the group whose IT could not be measured. Of the IT non-measurability, the sensitivity was 26.9%, the specificity was 95.9%, the positive predictive value was 21.9%, the negative predictive value was 96.9%, the accuracy rate was 93% and the odds ratio was 8.7 to predict the poor gestational prognosis mentioned above. Conclusion: The findings of our study make us think that intracranial translucency can be used as a parameter helping classical methods for the early diagnosis of the malformations of central nervous system and other systems, and some chromosomal anomalies, and that it can be useful to use it in routine perinatal assessment.