11–13+6 haftada fetal anatomiyi ne kadar de¤erlendirebiliriz?

Özet

Amaç: Rutin gebelik muayenesinin bir parças› olan 11–13+6 haftada anöploidi taramas›na ilave olarak fetal anatomik yap›lar›n farkl› CRL de¤erlerine göre ne oranda görüntülenebilece¤i saptamakt› r. Yöntem: Retrospektif tan›mlay›c› olgu serisi olarak planlanan çal› flmada, 1.4.2006–30.09.2017 tarihleri aras›nda, gebeli¤in 11–13+6 haftalar›nda nukal tarama yap›lan toplam 5238 tek fetüse ait veriler analiz edildi. Fetüsler CRL ölçümüne göre 4 gruba (CRL 45–54 mm aras› Grup 1, CRL 55–64 mm aras› Grup 2, CRL 65–74 mm aras› Grup 3, CRL 75–84 mm aras› Grup 4) ayr›ld›. Her grup için fetüsün organ ve vücut k›s›mlar›n›n görüntülenebilme oranlar› hesapland› ve istatistiksel analizleri yap›ld›. Bulgular: Gebelerin yafl ortalamalar› 30.1±4.65 (aral›k:17–46), fetüslerin ortanca CRL de¤eri 62 (aral›k: 45–84) mm idi. Tüm gruplarda fetal anatomi görüntüleme baflar›s› en yüksek olan organ ve bölümler s›ras›yla; üst ekstremite, alt ekstremite, kranyum, mide, mesane, ense kal›nl›¤›, burun kemi¤i, vertebra ve abdomen olarak belirlendi. Bu yap›lar›n hepsinde görüntüleme baflar›s› %90’›n üzerinde idi. Kalp dört odac›k tüm gruplarda %52.6 oran›nda, kalp büyük damar ç›k›fllar› tüm gruplarda %44.3 oran›nda izlendi. Böbreklerin tüm gruplarda %52.0 oran›nda gözlenebildi¤i belirlendi. CRL gruplar› aras›nda; kranyum, ense saydaml›¤›, abdomen duvar›, alt ve üst ekstremite hariç di¤er tüm anatomik yap›larda görüntüleme oranlar›, istatistiksel anlaml› olarak farkl›yd›. En düflük görüntüleme oranlar› Grup 1’de iken en yüksek oranlar Grup 4’te idi. Sonuç: Çal›flmam›zda 11–13+6 hafta anöploidi taramas› s›ras›nda, fetüsün kalp ve böbreklerin d›fl›nda kalan temel anatomik yap›lar›- n›n %90’›n üzerinde baflar›l› bir flekilde görüntülenebildi¤ini, görüntüleme oranlar›n›n beklendi¤i gibi gebelik haftas›na paralel olarak artt›¤› saptand›. Klasik olarak nukal tarama zamanlamas›nda 11-12 haftalar daha uygun iken fetal anatomi de¤erlendirmesi için 12-13. haftalar tercih edilebilir.

Abstract

Objective: The aim is to determine how much fetal anatomic structures can be displayed according to different CRL values in addition to the aneuploidy screening at 11–13+6 weeks which is a part of routine gestational examination. Methods: In the study planned to be as retrospective descriptive case series, we analyzed the data of a total of 5238 single fetuses which had nuchal screening at 11–13+6 weeks of gestation between April 1, 2006 and September 30, 2017. We separated fetuses into 4 groups according to the CRL measurements (Group 1: CRL between 45 and 54 mm, Group 2: CRL between 55 and 64 mm, Group 3: CRL between 65 and 74 mm, and Group 4: CRL between 75 and 84 mm). For each group, we calculated imaging rates of organ and body parts of fetuses and carried out statistical analyses. Results: The mean age of pregnant women was 30.1±4.65 (range: 17 to 46) years, and median CRL value of fetuses was 62 (range: 45 to 84) mm. In all groups, the organs and parts with the highest success of fetal anatomy imaging were upper extremity, lower extremity, cranium, stomach, bladder, nuchal translucency, nasal bone, vertebra and abdomen, respectively. The imaging rate for all of these structures was above 90%. A four-chambered heart could be identified in 52.6% of all groups, and cardiac outflow tracts were seen in 44.3% of all groups. It was found that kidneys were seen in 52.0% of all groups. Among CRL groups, imaging rates of all anatomic structures except cranium, nuchal translucency, abdominal wall and lower and upper extremities had statistically significant difference. While Group 1 had the lowest imaging rates, Group 4 had the highest rates. Conclusion: In our study, we found that basic fetal anatomic structures except heart and kidneys can be seen with a success rate over 90% during aneuploidy screening at 11–13+6 weeks of gestation, and as expected the imaging rates were increased parallel to the gestational week. Although the timing of the nuchal screening is favorable at 11th to 12th weeks classically, for the evaluation of fetal anatomy, 12th to 13th week are preferable.