Fetal Monitorizasyon Fizyolojisi
Özet
Fetal dolaşım umbilikal ven ile plasentadan gelen oksijenize kanın fetüsten umbilikal arterler aracılığıyla plasentaya geri dönmesi olarak tanımlanmaktadır. Fetal dolaşım sistemi erişkin dolaşım sistemine nazaran belirgin farklılıklar göstermektedir. Fetüsün ihtiyacı olan oksijenize kan ve temel besin maddeleri plasenta aracılığıyla karşılanmaktadır. Maternal- fetal alışveriş plasenta üzerinden sağlanmaktadır. Fetal kalp 22. gün itibarı ile çalışmaya başlar ve bu fetal dolaşımın başladığını gösterir. Fetal dolaşım, düşük sistemik venöz direnç ve yüksek pulmoner vasküler direnç ile karakterizedir. Fetal kalp hızı, beyin sapından kaynaklanan sempatik ve parasempatik sinir sistemi tarafından gelen otonomik uyarılar ile kontrol edilmektedir. Günümüzde fetal durumun değerlendirilmesinde; fetal solunum, hareket, tonus, fetal kalp hızı gibi fiziksel özellikler ve amniyotik sıvı hacmi ön planda kullanılmaktadır. Fetal durumun değerlendirilmesinde ultrasonografi, non-stres test (NST) , kontraksiyon stres testi (CST), biyofizik profili , amniyotik sıvı hacmi ve doppler velosimetri beraber kullanılmaktadır. Antepartum fetal durumun sağlıklı değerlendirilmesi ile hem gereksiz girişimler azalacak hem de fetal mortalite oranları düşecektir.
Fetal circulation is defined as the transport of oxygenated blood from the placenta to the fetus via the umbilical vein and the return of blood from the fetus to the placenta through the umbilical arteries. The fetal circulatory system exhibits significant differences compared to the adult circulatory system. The oxygenated blood and essential nutrients required by the fetus are supplied via the placenta. Maternal-fetal exchange is facilitated through the placenta. The fetal heart begins functioning as early as day 22, marking the commencement of fetal circulation. Fetal circulation is characterized by low systemic venous resistance and high pulmonary vascular resistance. The fetal heart rate is regulated by autonomic stimuli originating from the brainstem, involving both sympathetic and parasympathetic nervous systems. In contemporary evaluations of fetal well-being, physical parameters such as fetal respiration, movement, tone, heart rate, and the volume of amniotic fluid are prioritized. The assessment of fetal condition employs a combination of methods including ultrasonography, non-stress testing (NST), contraction stress testing (CST), biophysical profiling, amniotic fluid volume measurement, and Doppler velocimetry. A thorough antepartum evaluation of fetal health can reduce unnecessary interventions and lower fetal mortality rates.
Referanslar
Demirhan B. Plasentanın Klinik ve Histopatolojik İncelenme Yöntemleri ve Önemi Perinatoloji Dergisi. 1993; 246-255.
Sibley CP, Boyd, RD. Mechanisms of transfer across the human placenta. Fetal and neonatal physiology. 2004; 111-122.
Roberts VHJ, Morgan TK, Bednarek P. Early first trimester uteroplacental flow and the progressive disintegration of spiral artery plugs: new insights from contrast-enhanced ultrasound and tissue histopathology. Human Reproduction. 2017; 32(12), 2382-2393. doi: 10.1093/humrep/dex301
Olgac Y, Yildirim G, Dundar O. The Role Of PAPP-A and Uterine Artery Pulsatility Index In The Prediction of Preecplamsia. Jinekoloji Obstetrik Pediatri ve Pediatrik Cerrahi Dergisi. 2012; 4(3), 97–105. doi: 10.5222/JOPP.2012.097
Charnock-Jones DS, Burton GJ. Placental vascular morphogenesis. Best Practice & Research Clinical Obstetrics & Gynaecology. 2000; 14(6), 953-968. doi: 10.1053/beog.2000.0137
Ozcam H, Cimen G, Var A, Guldas, A. Sezaryenlerde Genel ve Spinal Anestezinin Maternal Etkileri. The Medical Journal of Okmeydani Training and Research Hospital. 2014; 30(3), 146–152. doi: 10.5222/otd.2014.146
Fleischer A, Anyaegbunam AA, Schulman H. Uterine and umbilical artery velocimetry during normal labor. American Journal of Obstetrics and Gynecology. 1987; 157(1), 40–43. doi: 10.1016/S0002-9378(87)80342-3
Yilmaz M, Isaoglu U, Delibas IB. Ulug, P. Placental abruption: Epidemiology, analysis of risk factors, fetal and maternal consequences. Sakarya Medical Journal. 2013; 3(3), 126–130. doi: 10.5505/sakaryamj.2013.55477
Finnemore A, Groves A. Physiology of the fetal and transitional circulation. Seminars in Fetal and Neonatal Medicine. 2015; 20(4), 210–216. doi: 10.1016/j.siny.2015.04.003
Kiserud T, Acharya G. The fetal circulation. Prenatal Diagnosis. 2004; 24(13), 1049–1059. doi: 10.1002/pd.1062
Teshome MK, Najib K, Nwagbara CC. Patent Foramen Ovale: A Comprehensive Review. Current Problems in Cardiology. 2020; 45(2), 100392. doi: 10.1016/j.cpcardiol.2018.08.004
Nageotte MP. Fetal heart rate monitoring. Seminars in Fetal and Neonatal Medicine. 2015; 20(3), 144–148. doi: 10.1016/j.siny.2015.02.002
Ray M, Freeman RK, Hesselgesser R. Clinical experience with the oxytocin challenge test. American Journal of Obstetrics and Gynecology. 1972; 114.1: 1-9.
Lagrew DC. The Contraction Stress Test. Clinical Obstetrics and Gynecology. 1995; 38(1), 11–25. doi: 10.1097/00003081-199503000-00005
Kirkwood CR, Eggertsen S. The fetal non-stress test. The Journal of Family Practice. 1983; 17(2), 311–319.
Nickelsen C, Weber T. The current status of intrapartum continuous fetal tissue pH measurements. J Perinat Med. 1991; 19(1-2):87-92. doi:10.1515/jpme.1991.19.1-2.87.
Snijders RJ, Nicolaides KH. Fetal biometry at 14–40 weeks’gestation. Ultrasound Obstet Gynecol 1994; 4: 34–48.
Antepartum fetal surveillance. Practice Bulletin No. 145. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2014; 124:182 – 92.
Baschat AA, Galan HL, Lee W. The role of the fetal biophysical profile in the management of fetal growth restriction. American Journal of Obstetrics and Gynecology. 2022; 226(4), 475–486. doi: 10.1016/j.ajog.2022.01.020
Wijngaard JA, Groenenberg IA, Wladimiroff JW. Cerebral Doppler ultrasound of the human fetus. Br J Obstet Gynaecol. 1989; 96: 845– 849.
Szymanski LM, Kogutt BK. Uterine Artery Doppler Velocimetry During Individually Prescribed Exercise in Pregnancy. Obstetrics & Gynecology. 2018; 132(4), 1026–1032. doi: 10.1097/AOG.0000000000002779
Lees CC, Romero R, Stampalija T. The diagnosis and management of suspected fetal growth restriction: an evidence-based approach. American Journal of Obstetrics and Gynecology. 2022; 226(3), 366–378. doi: 10.1016/j.ajog.2021.11.1357
Aliyeva G, Sucu M. Erken ve geç başlangıçlı intrauterin gelişme geriliğinin perinatal sonuçları, Turkey Cukurova Medical Journal. 2020; 45(4):1758-1767. doi: 10.17826/cumj.839861
Fetal growth restriction. Practice Bulletin No. 134. American College of Obstetricians and Gynecologists. Obstet Gynecol 2013;121:1122–33.
Figueras F, Caradeux J, Crispi F. Diagnosis and surveillance of late-onset fetal growth restriction. American Journal of Obstetrics and Gynecology. 2018; 218(2), S790-S802.e1. doi: 10.1016/j.ajog.2017.12.003
Referanslar
Demirhan B. Plasentanın Klinik ve Histopatolojik İncelenme Yöntemleri ve Önemi Perinatoloji Dergisi. 1993; 246-255.
Sibley CP, Boyd, RD. Mechanisms of transfer across the human placenta. Fetal and neonatal physiology. 2004; 111-122.
Roberts VHJ, Morgan TK, Bednarek P. Early first trimester uteroplacental flow and the progressive disintegration of spiral artery plugs: new insights from contrast-enhanced ultrasound and tissue histopathology. Human Reproduction. 2017; 32(12), 2382-2393. doi: 10.1093/humrep/dex301
Olgac Y, Yildirim G, Dundar O. The Role Of PAPP-A and Uterine Artery Pulsatility Index In The Prediction of Preecplamsia. Jinekoloji Obstetrik Pediatri ve Pediatrik Cerrahi Dergisi. 2012; 4(3), 97–105. doi: 10.5222/JOPP.2012.097
Charnock-Jones DS, Burton GJ. Placental vascular morphogenesis. Best Practice & Research Clinical Obstetrics & Gynaecology. 2000; 14(6), 953-968. doi: 10.1053/beog.2000.0137
Ozcam H, Cimen G, Var A, Guldas, A. Sezaryenlerde Genel ve Spinal Anestezinin Maternal Etkileri. The Medical Journal of Okmeydani Training and Research Hospital. 2014; 30(3), 146–152. doi: 10.5222/otd.2014.146
Fleischer A, Anyaegbunam AA, Schulman H. Uterine and umbilical artery velocimetry during normal labor. American Journal of Obstetrics and Gynecology. 1987; 157(1), 40–43. doi: 10.1016/S0002-9378(87)80342-3
Yilmaz M, Isaoglu U, Delibas IB. Ulug, P. Placental abruption: Epidemiology, analysis of risk factors, fetal and maternal consequences. Sakarya Medical Journal. 2013; 3(3), 126–130. doi: 10.5505/sakaryamj.2013.55477
Finnemore A, Groves A. Physiology of the fetal and transitional circulation. Seminars in Fetal and Neonatal Medicine. 2015; 20(4), 210–216. doi: 10.1016/j.siny.2015.04.003
Kiserud T, Acharya G. The fetal circulation. Prenatal Diagnosis. 2004; 24(13), 1049–1059. doi: 10.1002/pd.1062
Teshome MK, Najib K, Nwagbara CC. Patent Foramen Ovale: A Comprehensive Review. Current Problems in Cardiology. 2020; 45(2), 100392. doi: 10.1016/j.cpcardiol.2018.08.004
Nageotte MP. Fetal heart rate monitoring. Seminars in Fetal and Neonatal Medicine. 2015; 20(3), 144–148. doi: 10.1016/j.siny.2015.02.002
Ray M, Freeman RK, Hesselgesser R. Clinical experience with the oxytocin challenge test. American Journal of Obstetrics and Gynecology. 1972; 114.1: 1-9.
Lagrew DC. The Contraction Stress Test. Clinical Obstetrics and Gynecology. 1995; 38(1), 11–25. doi: 10.1097/00003081-199503000-00005
Kirkwood CR, Eggertsen S. The fetal non-stress test. The Journal of Family Practice. 1983; 17(2), 311–319.
Nickelsen C, Weber T. The current status of intrapartum continuous fetal tissue pH measurements. J Perinat Med. 1991; 19(1-2):87-92. doi:10.1515/jpme.1991.19.1-2.87.
Snijders RJ, Nicolaides KH. Fetal biometry at 14–40 weeks’gestation. Ultrasound Obstet Gynecol 1994; 4: 34–48.
Antepartum fetal surveillance. Practice Bulletin No. 145. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2014; 124:182 – 92.
Baschat AA, Galan HL, Lee W. The role of the fetal biophysical profile in the management of fetal growth restriction. American Journal of Obstetrics and Gynecology. 2022; 226(4), 475–486. doi: 10.1016/j.ajog.2022.01.020
Wijngaard JA, Groenenberg IA, Wladimiroff JW. Cerebral Doppler ultrasound of the human fetus. Br J Obstet Gynaecol. 1989; 96: 845– 849.
Szymanski LM, Kogutt BK. Uterine Artery Doppler Velocimetry During Individually Prescribed Exercise in Pregnancy. Obstetrics & Gynecology. 2018; 132(4), 1026–1032. doi: 10.1097/AOG.0000000000002779
Lees CC, Romero R, Stampalija T. The diagnosis and management of suspected fetal growth restriction: an evidence-based approach. American Journal of Obstetrics and Gynecology. 2022; 226(3), 366–378. doi: 10.1016/j.ajog.2021.11.1357
Aliyeva G, Sucu M. Erken ve geç başlangıçlı intrauterin gelişme geriliğinin perinatal sonuçları, Turkey Cukurova Medical Journal. 2020; 45(4):1758-1767. doi: 10.17826/cumj.839861
Fetal growth restriction. Practice Bulletin No. 134. American College of Obstetricians and Gynecologists. Obstet Gynecol 2013;121:1122–33.
Figueras F, Caradeux J, Crispi F. Diagnosis and surveillance of late-onset fetal growth restriction. American Journal of Obstetrics and Gynecology. 2018; 218(2), S790-S802.e1. doi: 10.1016/j.ajog.2017.12.003
