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Preterm Delivery: Epidemiologic and Neonatal Results

in Gulhana Military Medical Academy

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Tablo-3 Preterm do um tanı kriterleri Gestasyonel ya : 20-37 hafta Düzenli uterin kontraksiyon: 30 dk. da 5-8 defa gelen kontraksiyon Amniotik membranların rüptüre olması. E er intakt ise a a ıdaki bulguların en az birinin olması Servikal de i iklik Silinme > %75 Açıklık > 2 cm SONUÇ: Preterm do umların yenido an açısından görülen mortalite ve morbidite etkileri göz önüne alındı ında, bu do umların önlenmesi için önlenebilir risk faktörlerinin ortaya konulması, özellikle üriner

sistem ve bakteriyel vaginozis gibi erken membran rüptürü etyolojisinde etkili olan (25,26) infeksiyonların tedavisi önem arzetmektedir. Gerçek bir preterm eylem söz konusu oldu unda tokolitik tedavinin amacı, steroid uygulaması yapılarak pulmoner maturasyon açısından zaman kazanılması ve neonatal yo un bakım artlarının oldu u merkeze transfer edilmesidir.

Son yıllarda üremeye yardımcı tekniklerinin geli mesiyle birlikte, artan sayıda ço ul gebelik olgularıyla kar ıla maktayız. Bu tekniklerin daha uygun embriyo transfer edilerek, en fazla ikiz, tercihen tek gebelikler olu turulacak ekilde gerekirse fetal redüksiyon i lemleriyle kombine edilmesi, neonatal sonuçlar açısından daha yüz güldürücü olaca ı kanaatindeyiz.

KAYNAKLAR:

1. Keirse MJNC. New perspectives for the effective treatment of preterm labour. Am J Obstet Gynecol 1995;173:618-28. 2. R.L. Goldenberg, The management of preterm labor. Obstet Gynecol 100 (2002), pp. 1020–1037.

3. Morrison JC. Preterm birth: a puzzle worth solving. Obstet Gynecol 1990;76:5-12. 4. J.R. Challis, S.J. Lye, W. Gibb, W. Whittle, F. Patel and N. Alfaidy, Understanding preterm labor. Ann N Y Acad Sci 943 (2001),

pp. 225–234. 5. S.W. Wen, R.L. Goldenberg, G. Cutter, H.J. Hoffman and S.P. Cliver, Intrauterine growth retardation and preterm delivery:

prenatal risk factors in an indigent population. Am J Obstet Gynecol 162 (1990), pp. 213–218. 6. K. Demissie, G.G. Rhoads, C.V. Ananth, G.R. Allexander, M.S. Kramer, M.D. Kogan et al., Trends in preterm birth and neonatal

mortality among blacks and whites in the United States from 1989 to 1997. Am J Epidemiol 154 (2001), pp. 307–315. 7. P. Astolfi and L.A. Zonta, Risks of preterm delivery and association with maternal age, birth order, and fetal gender. Hum Reprod

14 (1999), pp. 2891–2894. 8. A. Rolett and J.L. Kiely, Maternal sociodemographic characteristics as risk factors for preterm birth in twins versus singletons.

Paediatr Perinat Epidemiol 14 (2000), pp. 211–218. 9. F.G. Cunningham, N.F. Gant, K.J. Leveno, L.C. Gilstrap, III, J.C. Hauth and K.D. Wenstrom, Editors, Williams obstetrics (21st

ed.), McGraw Hill, New York (2001), p. 780. 10. B.M. Sibai, S.N. Caritis, J.C. Hauth, C. McPherson, J.P. Van Dorsten, M. Klebanoff et al., Preterm delivery in women with

pregestational diabetes mellitus or chronic hypertension relative to women with uncomplicated pregnancies. The National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Am J Obstet Gynecol 183 (2000), pp. 1520–1524.

11. T.S. Gerstenfeld, D.T. Chang, A.R. Pliego and D.A. Wing, Nonobstetrical abdominal surgery during pregnancy in Women's Hospital. J Matern Fetal Med 9 (2000), pp. 170–172.

12. R. Romero, E. Oyarzun, M. Mazor, M. Sirtori, J.C. Hobbins and M. Bracken, Meta-analysis of relationship between asymptomatic bacteruria and preterm delivery/birth weight. Obstet Gynecol 73 (1989), pp. 576–582.

13. Iams JD. Prediction and early detection of preterm labor. Obstet Gynecol 2003;101:402-12. 14. J.K. Sinn, M.C. Ward and D.J. Henderson-Smart, Developmental outcome of preterm infants after surfactant therapy: systematic

review of randomized controlled trials. J Paediatr Child Health 38 (2002), pp. 597–600. 15. McNamara HM, Vintzileos AM. The clinical approach to preterm labour. In: Elder MG, Lamont RF, Romero R, (eds). Preterm

labor New York, Churchill Livingstone; 1997 p.207-242. 16. Magowan BA, Bain M, Juszczak E, McInneny K. Neonatal mortality amongst Scottish preterm singleton births (1985e1994). Br J

Obstet Gynaecol 1998;105:1005-10. 17. Wigton TR, Tamura RK, Wickstrom E, Atkins V, Deddish R, Socol ML. Neonatal morbidity after preterm delivery in the

presence of documented lung maturity. AmJ Obstet Gynecol 1993;169:951-5. 18. Copper RL, Goldenberg RL, Creasy RK, Du Bard MB, Davis RO, Entman SS, et al. A multicenter study of preterm birth weight

and gestational age-specific neonatal mortality. Am J Obstet Gynecol 1993;168:78-84. 19. Simchen MJ, Beiner ME, Strauss-Liviathan N, Dulitzky M, Kuint J, Mashiach S, et al. Neonatal outcome in growth-restricted

versus appropriately grown preterm infants. Am J Perinatol 2000;17:187-92. 20. Reiss I, Landmann E, Heckmann M, Misselwitz B, Gortner L. Increased risk of bronchopulmonary dysplasia and increased

mortality in very preterm infants being small for gestational age. Arch Gynecol Obstet 2003 Apr 8;269:40-4. 21. Rettwitz-Volk W, Tran TM, Veldman A. Cerebral morbidity in pretermtwins. J Matern Fetal Neonatal Med 2003;13:218-3. 22. Friedman SA, Schiff E, Kao L, Sibai BM. Neonatal outcome after preterm delivery for preeclampsia. Am J Obstet Gynecol

1995;172:1785-8. 23. Goldenberg RL, Rouse DJ. Prevention of premature birth. N Engl J Med 1998;339:313-20. 24. Leitich H, Kaider A. Fetal fibronectindhow useful is it in the prediction of preterm birth? Br J Obstet Gynaecol 2003; 110(Suppl

20):66-70. 25. J.C. Vazquez and J. Villar, Treatments for symptomatic urinary tract infections during pregnancy. Cochrane Database Syst Rev 3

(2000) CD002256 . 26. H. McDonald, P. Brocklehurst, J. Parsons and R. Vigneswaran, Antibiotics for treating bacterial vaginosis in pregnancy.

Cochrane Database Syst Rev 2 (2003) CD000262.

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DO RU SPERM N SEÇ LMES , SPERM MATÜR TES , DNA FRAGMANTASYONU, EMBRYO KAL TES

Selecting The Appropriate Sperm, Sperm Maturity, DNA Fragmentations, Embryo Quality Prof. Dr. Esat Orhon

ÖZET

Anahtar Kelimeler :ABSTRACT

Oosit : Rekombinant Fabrika

RES M 1:

Seks Kromozomlarının Fertilizasyondaki Rolü : DNA ntegritesi

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Tablo

KAYNAKLAR

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Tablo 2

Tablo

ablo

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(Resim

im 3'

sim

resim

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Tablo 1: Hemodinamik parametreler, pulse oksimetri ve PETCO2

Dakika

Parametre

0 5 10 15 20 30 40 50 60 75 90

KAH 110 100 100 90 92 84 86 85 80 83 86

SAB 150 132 125 124 118 114 122 129 128 136 135

DAB 85 72 70 71 69 70 75 78 74 77 76

OAB 107 93 96 92 87 84 91 95 94 99 97

SpO2 97 99 98 98 97 98 97 97 96 97 98

PETCO2 27 28 30 27 26 29 32 31 28

TARTI MA

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