Preecıampsıa in Turkey

Ayşe Kafkaslı

Künye

Preecıampsıa in Turkey. Perinatoloji Dergisi 2002;10(3):154-155

Yazar Bilgileri

Ayşe Kafkaslı

İnönü University, Turgut Özal Medical Center Department of Obstetrics and Gynaecology Malatya TR

Yazışma Adresi

Ayşe Kafkaslı, İnönü University, Turgut Özal Medical Center Department of Obstetrics and Gynaecology Malatya TR,

Yayın Geçmişi

Çıkar Çakışması

Çıkar çakışması bulunmadığı belirtilmiştir.

Giriş

Preeclampsia is the most common hypertensive disorder of pregnaney, with the incidence of %2-35.The incidence varies in accordance with the criteria used for diagnosis and the population studied mortalily. Maternal mortality due to hypertensive disorders is 1.5, 7, 9.1 per 100.000 live birth in Netherlands, in United Kingdom, in United States of America respeetively. İn developing and underdeveloped countries the rate is high as 420 and 640 per 100.000 live birth in Asia and Africa respeetively. in Turkey maternal mortality rate due to preeclampsia varies between referance centers, the range is %0.0- %20.1 among the maternal deaths from ali direct and indirect obstetric causes. Although preeclampsia is reported to be the seconel most common caııse of maternal mortalily following the postpartum bleeding in Turkey, national data are lacking. The objective of this study was to collect and analyze the data in Turkey.

Yöntem

A questionnaire was prepared to collect the data on the type of the preeclampsia, maternal mortality and morbidity rate, gestational age at delivery, the mode of delivery, birth weight of the neonate, previous history of preeclampsia and maternal age. Department of Obstetrics and the data colleeted fıom 7 University, 1 HMM and 1 HSII were analyzed. Data Analysis:Data analasis was performed by using SPSS software. Comparison among groups for characteristics of centers was performed by oneway variance analysis. A p value <0.005 was considered significant.

Bulgular

From 9 centers data about 1316 cases collected.Centers were symbolized with numbers. Seventy-two pecent of the patients' age were between 19-35 years.Mean maternal age was 28,40±6,9 ye-ars (range betweenl6-44year). The incidence of mild, moderate and severe preeclampsia were %42.6, %27.3 and%29.9 respeetively. Most of the severe cases were fom center 9 (Cerrahpaşa, İstanbul ).The rate of mild preeclampsia was almost same in all centers. Out of 1312 cases 484(%36.8) were nulliparous and 733(%36.6) were grandmultiparous. Nearly five percent of the cases had a previous preeclampsia history. But there was no correlation between the type of the preeclampsia and previous history of preeclampsia. The high rate of cesarean section in the severe cases is statistically significant (p<0.005 ). Cesarean section was the prefered mode of the delivery in the severe cases with the rate of %53 in the study population. Cesarean section indications were due to maternal conditions in % 45.3 of the cases. in mild preeclampsia group both the mean gestational age and neonatal weight were higher than the se¬vere preeclampsia group. This difference was statistically significant p<0.005.The incidence of cases with gestational age between 28-37 week was %78.9. Different therapeutic regimens were prefered by the centers, but the main therapeutic agents administeled in the centers was MgSO4 (i.v).Even in the mild preeclampsia MgSO4 (i.v) was the drug of choice.

Tartışma

This is the first study condueted to evaluate the incidence and the national epidemiological data aboui the preeclampcia in Turkey. Several studies from different Turkish centers with small numbers and various parameters were published both in Turkish and English litureture. But the data colleclecl in this study have been showened that there was no uniformity in the registration of the patients. Ivlean maternal age w a s 28,4()±6.9 years. in contrast with the other studies there was no significant difference between ma¬ternal age and the severity of preeclampcia Although preeclampcia is reported to be the predominantly a clisease of primigravidae, in this study the rate of primigravidity was %36.8. The rate of previous history of preeclampcia was %5. İn the literatüre recurrence rate was reported as 'Ki 13 and %18 in the primiparous and multiparous respeetively. Despite the high multiparity rate(%632) in the study the recurrence nite vvas found to be low wlıen compare to tlıe literatüre. Mocle of delivery was cesarean section in %45.3 of tlıe cases due to maternal condıtıons.Although there is a general consideration as preeclamp.sia is not an indication for cesarean section, cesarean seclion stili was found to be the most comnıon mode of delivery in preeclampsia in the study. MgSO4(i.v) administration vvas the first and the a-metlıyldopa vvas the second choice of therapeutic agent in the management of all types of preeclampsia.The rate of MgSO4(i.v) administration in the mild preec¬lampsia was %36.15.

Sonuç

Demographic characteristics of preeclampsia are different in variuos geographical region.In orcler to re ach the correct data from different regions, and better understandıng of the epıclemıology of the clısease uniform data collection and analysis must be done. Preeclampsia is the most but not the first cause of maternal mortality in Turkey. There must be an agrement about the management in all types of preeclampsia ıncludıng the mode ot delivery. Epidemiological data from eveıy health care center will provide the intormation about tlıe real inciden-ce and the demographic characteristics of the disease in Turkey, which can be different from the other geographical parts of the world.

Anahtar Kelimeler

Kaynaklar

1. Witlin AG, Sibai BH.Hypertensive Diseases in Pregnancy. ln:Reece EA, Hohhins JC (cclsJ Medicint' of tlıe Fetus and Motlıer, 2nd. ed. Lippincott-Raven Puhlishers, Plıiladelphia, 1999:997-1020.
2. Eyck J v:ın, 13oer WF, Grol WB, Arabin B.Epiclemiology of pre-eclampsia in The Netherl:ınds. ln:Clıcrvenak FA. Kurjak A.(eds) Fetal Medicine The Clinicıl Care Of Tlıe Fetus A􀏗 A Patient. Thc Partbenon Publishing Group, N_ew York, 1999:343-316.
3 Fox H. Patlıology of maternal cleatlı. in Fox il, Wells M (ecls).Obstetric ancl Gynecological l'atl10- logy. Churchill Livingsrone, London, 1995: 1837-51.
4. Aksu MF, Ak F, Çolgar U, Karaalilcr Ş. Gebeliğin llipertansif Hastalığı. Cerrahp:ı,􀏘a Tıp Fak. Derg. 1985; 16A7-53 'i. Yıldırım A, Dölen İ, Karacaclağ O ve ark. 1':i5 G.E.P.H'lı olgunun değerlcndirilım·,i. Zevncp K:ıınil Tıp Bülteni 1987; 19(2):545-556
6. Gül T, Erden AC, Kocalxığlı C. Preeklamptik ve eklamprik 275 olgunun incelt'nmesi. Dide Tıp Dergisi (Journal of Meclical School) 1993;20:50-57
7. Osmanağaoğlu O, Cengizoğlu 13, Ünsal M ve :ırk. Gebelik ve Hipertansiyonda Maternal ve Perinntal Mortalite ve Morbiclite. Perinatoloji Dergisi. l 9()5;4:44- ı<ı
8. Erden AC, Yayla M. Preeklampsi ve Eklampsicle M:ıtern;ıl FL"Lıl Morhiclite-Mortalite. Perinatoloji Dergisi. 1993:1:24-30
9. Şen C, Y:ıyl:ı M. Preeklaınpsicle Maternal Mort:ılite \' C Morhiclik l'crin:ııoloji Dergisi 1999:7(:)):21':7- 232 rn. Güvenal T, Demirköprülü N, Çullıaoğlu Y ve ark. l'rcekLııııpsi ve HELLI' Sendromu Olgııl:ırırnLı ı\ıLırernal
ve Fetal Sonuçlar. Jinekoloji ve Obstetrik Dergisi 2001; l 'i: 180-1
11. Yücesoy İ, Baysal G, İnan A ve ark. Zeynep Kamil Kaclın ve Çocuk J--lasulıkları J-last:ınesinde Pcrinat: ıl Maternal Mortalite. Zeynep Kamil Tıp Bülteni 1989; 626-630
12. Karabey Ö, Yazıoğlu F, Kavas T ve ark. Şişli Etf:ıl Hastanesi 1. Kadın -Doğum Kliniği 5 Yıllık M:ıtern: ıl Mortalite I Iızı.Zeynep K:ımil Tıp Bülteni 1990: 877-880
13. Sahin HG, Şahin HA, K:ımacı M, ve ark.Van ve Yöresinde Maternal Mortalite Oranı vt: Etyolojidc Rol Alan Faktiırlerin Tespiti. Perinatoloji Dergisi 2001:9:252-2S5 J ,L
14.Durırnıs R, Kaya İ, Kama.􀏙 A. I Jealtlı Statistics. Rcpuhlic of Turkey Minisrıy of Healtlı Research, l'laning :ıncl Coordination Council,2000; 4-57