Sažetak
Uvod/Cilj. Blizanci nastali tehnikama asistirane reprodukcije (ART) su najosetljiviji na pojavu perinatalnih komplikacija. Cilj rada bio je da se ispita uloga prenatalnog neinvazivnog fetalnog skrininga prvog i drugog trimestra u predviđanju vremena porođaja blizanaca nastalih metodama ART. Metode. Prospektivna kohortna studija kojom su obuhvaćene sve blizanačke trudnoće nastale ART metodama sprovedena je na Klinici za ginekologiju i akušerstvo Kliničkog centra Srbije u periodu od 01.01.2016. do 31.12.2017. U 12. gestacionoj nedelji (GN) ultrasonografski su blizancima izmereni razmak teme-trtica (CRL) i nuhalno zadebljanje (NT). Takođe, određeni su serumski nivoi beta podjedinice humanog horionskog gonadotropina (β hCG) i plazma proteina A povezanog sa trudnocćom (PAPPA). U 17. GN ultrasonografski su blizancima izmereni biparietalni dijametar (BPD), obim abdomena (AC) i dužine femura (FL). Pored toga, β hCG, alfa fetoprotein (AFP), estriol (E3) i inhibin (INH) su izmereni u serumu majki. Za svaku trudnoću zabeležena je GN porođaja. Rezultati. Studija je obuhvatila 100 trudnica koje su u proseku imale 35,44 ± 5,82 godina života. U ispitivanom uzorku blizanaca, nastalih tehnikama ART, značajno više (51%) je bilo porođeno u terminu (≥ 35 GN) (p = 0,001). Vreme porođaja je negativno korelisalo sa NT i nivoima serumskog β hCG u prvom trimestru, dok je pozitivno korelisalo sa FL manjeg blizanca, kao i koncentracijama β hCG, AFP i E3 u drugom trimestru. Prema dobijenom modelu za predviđanje vremena porođaja blizanaca nastalih tehnikom ART, na osnovu dijagnostičkih testova prvog i drugog trimestra, značajni prediktori bili su PAPPA i β hCG u 12. GN, kao i NT prvog većeg blizanca. Ipak, pouzdanost (senzitivnost 50%–75%, specifičnost 30%–40%) tih dijagnostičkih testova bila je umerena. Zaključak. Prenatalni neinvazivni fetalni skrining prvog i drugog trimestra (ultrasonografija i laboratorijsko testiranje) može se koristiti za predviđanje vremena porođaja blizanaca nastalih metodama ART.
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Reference
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