{"id":1632,"date":"2024-12-28T00:00:00","date_gmt":"2024-12-27T22:00:00","guid":{"rendered":"https:\/\/gynaikologos-komotini.gr\/?p=1632"},"modified":"2026-06-18T13:50:02","modified_gmt":"2026-06-18T10:50:02","slug":"kucuk-fetus","status":"publish","type":"post","link":"https:\/\/gynaikologos-komotini.gr\/tr\/kucuk-fetus\/","title":{"rendered":"K\u00fc\u00e7\u00fck fet\u00fcs"},"content":{"rendered":"\t\t
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Tan\u0131m<\/h4>

K\u00fc\u00e7\u00fck fet\u00fcs (Small for Gestational Age – SGA), ultrasonografik incelemede tahmini fetal a\u011f\u0131rl\u0131\u011f\u0131 10. persentilin alt\u0131nda olan fet\u00fcs olarak tan\u0131mlan\u0131r. Bu grup t\u00fcm fet\u00fcslerin yakla\u015f\u0131k %10\u2019unu olu\u015fturur.<\/p>

Bu grubun i\u00e7inde;<\/p>

  • \u0130ntrauterin \u00f6l\u00fcm veya perinatal asfiksi a\u00e7\u0131s\u0131ndan y\u00fcksek risk ta\u015f\u0131yan fet\u00fcsler (%40),<\/li>
  • Yap\u0131sal olarak k\u00fc\u00e7\u00fck (konstit\u00fcsyonel olarak k\u00fc\u00e7\u00fck) fet\u00fcsler (%40),<\/li>
  • Kromozomal anomaliler veya \u00e7evresel etkiler nedeniyle k\u00fc\u00e7\u00fck olan fet\u00fcsler (%20)<\/li><\/ul>

    yer almaktad\u0131r.<\/p>

    Birinci ve son alt grupta, tahmini fetal a\u011f\u0131rl\u0131\u011f\u0131 3. persentilin alt\u0131nda olan fet\u00fcsler ile 3.\u201310. persentiller aras\u0131nda olup Doppler ultrasonografide anormal kan ak\u0131m\u0131 g\u00f6steren fet\u00fcsler bulunur.<\/p>

    Bu fet\u00fcslerde b\u00fcy\u00fcme gerili\u011fi (Fetal Growth Restriction – FGR) veya intrauterin geli\u015fme gerili\u011fi s\u00f6z konusudur; \u00e7\u00fcnk\u00fc gebelik boyunca a\u011f\u0131rl\u0131k art\u0131\u015flar\u0131, gebelik haftalar\u0131na uygun biyolojik b\u00fcy\u00fcme potansiyellerini takip etmemektedir.<\/p>

    Bununla birlikte, fetal a\u011f\u0131rl\u0131k hesaplamas\u0131n\u0131n bir\u00e7ok de\u011fi\u015fkenden etkilendi\u011fi ve \u00e7o\u011fu zaman ger\u00e7ek do\u011fum a\u011f\u0131rl\u0131\u011f\u0131 ile tam olarak \u00f6rt\u00fc\u015fmedi\u011fi unutulmamal\u0131d\u0131r. Bu nedenle, \u00f6zellikle s\u0131n\u0131rda olgularda, ebeveynlere gebeli\u011fin olas\u0131 sonucu hakk\u0131nda dan\u0131\u015fmanl\u0131k verirken dikkatli olunmal\u0131d\u0131r.<\/p>

    \"\"

    Do\u011fum A\u011f\u0131rl\u0131\u011f\u0131 ve Perinatal Mortalite<\/p><\/div>

    Artm\u0131\u015f \u00f6l\u00fcm riski yaln\u0131zca a\u011f\u0131rl\u0131\u011f\u0131 10. persentilin alt\u0131nda olan fet\u00fcslerle s\u0131n\u0131rl\u0131 de\u011fildir.<\/p>

    1,2 milyon gebeli\u011fi i\u00e7eren Hollanda kaynakl\u0131 bir \u00e7al\u0131\u015fma, intrauterin \u00f6l\u00fcm riskinin do\u011fum a\u011f\u0131rl\u0131\u011f\u0131 80. persentilin alt\u0131na d\u00fc\u015ft\u00fc\u011f\u00fcnde artmaya ba\u015flad\u0131\u011f\u0131n\u0131, 50.\u201320. persentiller aras\u0131nda belirginle\u015fti\u011fini ve \u00f6zellikle 2,3. persentilin alt\u0131nda \u00e7ok daha fazla artt\u0131\u011f\u0131n\u0131 g\u00f6stermi\u015ftir.<\/p>

    Genel olarak do\u011fum a\u011f\u0131rl\u0131\u011f\u0131n\u0131n 10. persentilin alt\u0131nda olmas\u0131 durumunda:<\/p>

    • \u0130ntrauterin \u00f6l\u00fcm riski 5 kat artmaktad\u0131r.<\/li>
    • N\u00f6rogeli\u015fimsel testlerde d\u00fc\u015f\u00fck skor alma riski artmaktad\u0131r.<\/li>
    • Eri\u015fkin ya\u015famda diyabet geli\u015fme riski artmaktad\u0131r.<\/li><\/ul>

      DIGITAT \u00e7al\u0131\u015fmas\u0131, do\u011fum a\u011f\u0131rl\u0131\u011f\u0131n\u0131n 2,3. persentilin alt\u0131nda olmas\u0131n\u0131n ya\u015fam\u0131n ilk iki y\u0131l\u0131nda k\u00f6t\u00fc n\u00f6rogeli\u015fim i\u00e7in en g\u00fc\u00e7l\u00fc \u00f6ng\u00f6r\u00fcc\u00fc fakt\u00f6r oldu\u011funu g\u00f6stermi\u015ftir.<\/p>

      Bu nedenle, b\u00fcy\u00fcme gerili\u011finden \u015f\u00fcphelenmek i\u00e7in bir s\u0131n\u0131r belirlenmesi gerekiyorsa, 3. persentilin daha uygun oldu\u011fu d\u00fc\u015f\u00fcn\u00fclmektedir. Ancak tan\u0131sal ama\u00e7larla d\u00fcnya genelinde 10. persentil kullan\u0131lmaktad\u0131r.<\/p>

      \"\"

      B\u00fcy\u00fcme H\u0131z\u0131<\/p><\/div>

      \u0130ntrauterin \u00f6l\u00fcmlerin %60\u201370\u2019inin gebelik boyunca a\u011f\u0131rl\u0131\u011f\u0131 10. persentilin \u00fczerinde olan fet\u00fcslerde ger\u00e7ekle\u015fti\u011fi g\u00f6z \u00f6n\u00fcne al\u0131nd\u0131\u011f\u0131nda, ard\u0131\u015f\u0131k biyometri \u00f6l\u00e7\u00fcmleri aras\u0131nda b\u00fcy\u00fcme h\u0131z\u0131ndaki azalma da b\u00fcy\u00fcme gerili\u011finden \u015f\u00fcphelenmede \u00f6nemli bir kriterdir.<\/p>

      \u00a0<\/div><\/div><\/div><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t
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      S\u0131n\u0131fland\u0131rma<\/h4>

      B\u00fcy\u00fcme gerili\u011fi olan fet\u00fcsler iki ana gruba ayr\u0131l\u0131r:<\/p>

      1. Anatomik anomalilerle birlikte bulunan b\u00fcy\u00fcme gerili\u011fi.<\/li>
      2. \u0130zole b\u00fcy\u00fcme gerili\u011fi.<\/li><\/ol>

        \u0130zole b\u00fcy\u00fcme gerili\u011finin nedenleri \u015funlard\u0131r:<\/p>

        • Plasental yetmezlik<\/li>
        • Konjenital enfeksiyonlar (\u00f6zellikle sitomegalovir\u00fcs enfeksiyonu)<\/li>
        • Anne ya\u015f\u0131n\u0131n \u00e7ok gen\u00e7 veya ileri olmas\u0131<\/li>
        • Toksik maddelere maruziyet<\/li>
        • Anne taraf\u0131ndan madde kullan\u0131m\u0131<\/li>
        • Fet\u00fcse ait genetik anomaliler<\/li><\/ul>

          Genetik anomaliler:<\/p>

          • Kromozomal anomaliler<\/li>
          • Monogenik hastal\u0131klar<\/li>
          • Submikroskopik anomaliler<\/li><\/ul>

            Hekimin temel amac\u0131 b\u00fcy\u00fcme gerili\u011finin nedenini belirleyerek \u00e7ifti gebeli\u011fin olas\u0131 sonucu konusunda do\u011fru \u015fekilde bilgilendirmektir.<\/p>

            Erken ve Ge\u00e7 Ba\u015flang\u0131\u00e7l\u0131 B\u00fcy\u00fcme Gerili\u011fi<\/h4>

            B\u00fcy\u00fcme gerili\u011finin ilk ortaya \u00e7\u0131kt\u0131\u011f\u0131 gebelik haftas\u0131 b\u00fcy\u00fck \u00f6nem ta\u015f\u0131r:<\/p>

            • <26 hafta: \u00c7ok erken ba\u015flang\u0131\u00e7l\u0131<\/li>
            • 26\u201332 hafta: Erken ba\u015flang\u0131\u00e7l\u0131<\/li>

            • 32 hafta: Ge\u00e7 ba\u015flang\u0131\u00e7l\u0131<\/p><\/blockquote><\/li><\/ul>

              Genel kural olarak:<\/p>

              B\u00fcy\u00fcme gerili\u011fi ne kadar erken ba\u015flar ve ne kadar \u015fiddetliyse, gebelik sonucu a\u00e7\u0131s\u0131ndan risk o kadar y\u00fcksektir.<\/strong><\/p>

              Ba\u015flang\u0131\u00e7 zaman\u0131 ayn\u0131 zamanda Doppler bulgular\u0131 ile ili\u015fkilidir.<\/p>

              • Anne uterin arterlerinde ve fet\u00fcs umbilikal arterlerinde anormal ak\u0131m \u2192 Erken ba\u015flang\u0131\u00e7l\u0131 FGR<\/li>
              • Fet\u00fcste orta serebral arterde kan ak\u0131m\u0131n\u0131n yeniden da\u011f\u0131l\u0131m\u0131 \u2192 Ge\u00e7 ba\u015flang\u0131\u00e7l\u0131 FGR<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t
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                Etiyoloji<\/h4>

                Kromozomal Anomaliler<\/h4>

                Kromozomal anomaliler b\u00fcy\u00fcme gerili\u011fi olan fet\u00fcslerin yakla\u015f\u0131k %19\u2019unu olu\u015fturur.<\/p>

                En s\u0131k g\u00f6r\u00fclenler:<\/p>

                • 26 haftadan \u00f6nce: Triploidi<\/li>
                • 26 haftadan sonra: Trizomi 18<\/li><\/ul>

                  \u0130zole b\u00fcy\u00fcme gerili\u011finde kromozomal anomalilerin s\u0131kl\u0131\u011f\u0131 %6,4\u2019t\u00fcr.<\/p>

                  Ba\u015fka bir \u00e7al\u0131\u015fmada:<\/p>

                  • 32 haftadan \u00f6nce %7<\/li>
                  • 32 haftadan sonra %1,8<\/li><\/ul>

                    olarak bildirilmi\u015ftir.<\/p>

                    Risk, b\u00fcy\u00fcme gerili\u011finin \u015fiddeti ile artmaktad\u0131r:<\/p>

                    • <10. persentil \u2192 %7,8<\/li>
                    • <5. persentil \u2192 %10<\/li>
                    • <3. persentil \u2192 %18<\/li><\/ul>
                      \"\"

                      Metafaz evresinde ekstra 21. kromozomu g\u00f6steren konvansiyonel fetal karyotip<\/p><\/div>

                      \"\"

                      Mikrodizi tabanl\u0131 kar\u015f\u0131la\u015ft\u0131rmal\u0131 genomik hibridizasyon (array CGH)<\/p><\/div>

                      Plasental Mozaisizm<\/h4>

                      Baz\u0131 durumlarda kromozomal anomali yaln\u0131zca plasentada bulunur ve fet\u00fcs normaldir.<\/p>

                      Bu duruma Konfined Plasental Mozaisizm (CPM)<\/strong> ad\u0131 verilir ve s\u0131kl\u0131\u011f\u0131 %9\u201316\u2019d\u0131r.<\/p>

                      Buna ra\u011fmen fetal b\u00fcy\u00fcme gerili\u011fine neden olabilir.<\/p>

                      Koryon villus \u00f6rneklemesinde %1\u20132 oran\u0131nda saptan\u0131r.<\/p>

                      NIPT sonras\u0131nda g\u00f6r\u00fclen oranlar:<\/p>

                      • Trizomi 21: %2<\/li>
                      • Trizomi 18: %4<\/li>
                      • Trizomi 13: %33<\/li><\/ul>

                        Ger\u00e7ek fetal mozaisizmden ay\u0131r\u0131c\u0131 tan\u0131 yaln\u0131zca amniyosentez ile yap\u0131labilir.<\/p>

                        CPM en s\u0131k \u015fu kromozomlar\u0131 etkiler:<\/p>

                        • 2<\/li>
                        • 7\u201310<\/li>
                        • 13\u201318<\/li>
                        • 21<\/li>
                        • 22<\/li><\/ul>

                          ve genellikle olumsuz gebelik sonu\u00e7lar\u0131 ile ili\u015fkilidir.<\/p>

                          \u00d6zellikle kromozom 16 mozaisizmi \u00f6nemlidir:<\/p>

                          • Normal sonu\u00e7: %20\u201336<\/li>
                          • Yap\u0131sal olarak k\u00fc\u00e7\u00fck fet\u00fcs: %43\u201358<\/li>
                          • Anatomik anomaliler: %20\u201322<\/li>
                          • Preeklampsi: %16\u201324<\/li>
                          • Premat\u00fcrite: %32\u201337<\/li><\/ul>

                            Submikroskopik Kromozomal Anomaliler<\/h4>

                            Submikroskopik kromozomal anomaliler yaln\u0131zca molek\u00fcler karyotipleme (kromozomal mikroarray) ile saptanabilir ve Kopya Say\u0131s\u0131 Varyasyonlar\u0131 (Copy Number Variants – CNV)<\/strong> olarak adland\u0131r\u0131l\u0131r.<\/p>

                            Yak\u0131n zamanda yap\u0131lan bir \u00e7al\u0131\u015fmada, klasik karyotipi normal olan b\u00fcy\u00fcme gerili\u011fi bulunan fet\u00fcslerde patolojik CNV oran\u0131 %5,7 olarak bulunmu\u015ftur. Bu nedenle, klasik karyotipe ek olarak molek\u00fcler karyotiplemenin de yap\u0131lmas\u0131 \u00f6nerilmektedir.<\/p>

                            Bir meta-analizde, molek\u00fcler karyotiplemenin tan\u0131sal katk\u0131s\u0131:<\/p>

                            • \u0130zole b\u00fcy\u00fcme gerili\u011finde %4,<\/li>
                            • Anatomik anomaliler e\u015flik etti\u011finde %10<\/li><\/ul>

                              olarak bildirilmi\u015ftir.<\/p>

                              Monogenik Hastal\u0131klar<\/h4>

                              B\u00fcy\u00fcme gerili\u011fi olan fet\u00fcslerde, \u00f6zellikle \u00e7ok a\u011f\u0131r b\u00fcy\u00fcme gerili\u011fi (<1. persentil) bulunan olgularda, do\u011fum sonras\u0131 k\u0131sa boydan sorumlu \u00e7e\u015fitli genler ve iskelet sistemi anomalilerine neden olan ba\u015fka genler tan\u0131mlanm\u0131\u015ft\u0131r.<\/p>

                              Monogenik hastal\u0131klara ba\u011fl\u0131 b\u00fcy\u00fcme gerili\u011fi g\u00f6steren fet\u00fcsler iki gruba ayr\u0131labilir:<\/p>

                              1. T\u00fcm biyometrik parametrelerin etkilendi\u011fi grup<\/p>

                              • Ba\u015f \u00e7evresi<\/li>
                              • Kar\u0131n \u00e7evresi<\/li>
                              • Uzun kemikler<\/li><\/ul>

                                birlikte k\u00fc\u00e7\u00fckt\u00fcr.<\/p>

                                2. Sadece uzun kemiklerin etkilendi\u011fi grup<\/p>

                                Uzun kemik uzunlu\u011fu ortalaman\u0131n 3 standart sapmas\u0131ndan daha k\u0131sa olup (<3 SD), altta yatan bir iskelet displazisini d\u00fc\u015f\u00fcnd\u00fcr\u00fcr ve ayr\u0131nt\u0131l\u0131 inceleme gerektirir.<\/p>

                                \"\"

                                Fet\u00fcs Genomunun \u0130ncelenmesinde Kullan\u0131lan Y\u00f6ntemler
                                WES (Whole Exome Sequencing)
                                Genomdaki t\u00fcm kodlay\u0131c\u0131 b\u00f6lgelerin incelenmesidir.
                                Targeted Sequencing
                                Genomun belirli b\u00f6lgelerinin veya se\u00e7ilmi\u015f genlerin analizidir..<\/p><\/div>

                                \u00a0<\/h4>

                                Epigenetik Fakt\u00f6rler<\/h4>

                                Epigenetik, son yirmi y\u0131lda h\u0131zla geli\u015fen bir genetik bilim dal\u0131d\u0131r ve \u00e7evresel fakt\u00f6rlerin gen ekspresyonu \u00fczerindeki etkilerini ara\u015ft\u0131r\u0131r.<\/p>

                                \u0130ncelenen \u00e7evresel fakt\u00f6rler aras\u0131nda:<\/p>

                                • Toksik maruziyetler<\/li>
                                • Beslenme<\/li>
                                • Ruhsal durum<\/li>
                                • Fiziksel aktivite<\/li>
                                • \u00c7evresel ko\u015fullar<\/li><\/ul>

                                  yer almaktad\u0131r.<\/p>

                                  Bu durum, ki\u015finin normal genler ta\u015f\u0131mas\u0131na ra\u011fmen hastal\u0131k geli\u015ftirebilmesini veya patolojik genlere sahip olmas\u0131na ra\u011fmen sa\u011fl\u0131kl\u0131 kalabilmesini a\u00e7\u0131klayabilir.<\/p>

                                  Dolay\u0131s\u0131yla genler sabit yap\u0131lar de\u011fildir; \u00e7evresel ko\u015fullara g\u00f6re faaliyetlerini de\u011fi\u015ftirebilen dinamik yap\u0131lard\u0131r.<\/p>

                                  Fetal geli\u015fimi etkileyen \u00f6nemli epigenetik fakt\u00f6rlere \u00f6rnek olarak:<\/p>

                                  • Sigara kullan\u0131m\u0131<\/li>
                                  • Hava kirlili\u011fi<\/li>
                                  • \u00c7evresel toksinler<\/li><\/ul>

                                    verilebilir.<\/p>

                                    \u00a0<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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                                    B\u00fcy\u00fcme Gerili\u011fi Olan Fet\u00fcslerin Takibi<\/h4>

                                    Erken ba\u015flang\u0131\u00e7l\u0131 fetal b\u00fcy\u00fcme gerili\u011finde genellikle belirgin plasental yetmezlik bulunur.<\/p>

                                    Bu nedenle fet\u00fcse ait damarlar\u0131n Doppler incelemesinde:<\/p>

                                    • Umbilikal arter<\/li>
                                    • Orta serebral arter<\/li>
                                    • Duktus venozus<\/li><\/ul>

                                      bulgular\u0131, 32. gebelik haftas\u0131ndan \u00f6nce do\u011fan olgular\u0131n yakla\u015f\u0131k %80\u2019inde anormaldir.<\/p>

                                      Bu durum s\u0131kl\u0131kla a\u015fa\u011f\u0131daki bulgularla birliktedir:<\/p>

                                      • Oligohidramniyos<\/li>
                                      • Kardiyotokografide (KTG) deselerasyonlar<\/li>
                                      • Anormal biyofizik profil<\/li><\/ul>

                                        \u0130ntrauterin \u00f6l\u00fcm riski %0\u20134 aras\u0131ndad\u0131r.<\/p>

                                        Do\u011fum haftas\u0131 neonatal ya\u015fam a\u00e7\u0131s\u0131ndan kritik \u00f6neme sahiptir.<\/p>

                                        26 haftadan \u00f6nce ve 500 gram\u0131n \u00fczerinde do\u011fan bebeklerin yaln\u0131zca yakla\u015f\u0131k %50\u2019si hayatta kalabilmektedir.<\/p>

                                        Bundan sonra her gebelik haftas\u0131nda:<\/p>

                                        • Sa\u011fkal\u0131m yakla\u015f\u0131k %2 artar.<\/li>
                                        • N\u00f6rogeli\u015fimsel sorunlar\u0131n riski azal\u0131r.<\/li><\/ul>
                                          \"\"

                                          A\u015f\u0131r\u0131 premat\u00fcre yenido\u011fanlarda sa\u011fkal\u0131m oranlar\u0131 ve n\u00f6rogeli\u015fimsel sonu\u00e7lar<\/p><\/div>

                                          \u00c7ok Erken Do\u011fan Bebeklerde Sa\u011fkal\u0131m ve N\u00f6rogeli\u015fim<\/h4>

                                          Ge\u00e7 ba\u015flang\u0131\u00e7l\u0131 b\u00fcy\u00fcme gerili\u011finde (\u00fc\u00e7\u00fcnc\u00fc trimesterde ortaya \u00e7\u0131kan) plasental yetmezlik daha hafiftir.<\/p>

                                          Bu nedenle:<\/p>

                                          • Umbilikal arter Doppler bozuklu\u011fu yaln\u0131zca %5 oran\u0131nda,<\/li>
                                          • Duktus venozus Doppler bozuklu\u011fu ise %0,1 oran\u0131nda<\/li><\/ul>

                                            g\u00f6r\u00fcl\u00fcr.<\/p>

                                            Buna kar\u015f\u0131n:<\/p>

                                            • Amniyotik s\u0131v\u0131 bozukluklar\u0131<\/li>
                                            • Anormal biyofizik profil<\/li>
                                            • KTG deselerasyonlar\u0131<\/li><\/ul>

                                              olgular\u0131n yakla\u015f\u0131k %40\u2019\u0131nda bulunur.<\/p>

                                              1. haftada intrauterin \u00f6l\u00fcm riski yakla\u015f\u0131k:<\/li><\/ol>

                                                11 \/ 10.000<\/strong><\/p>

                                                olarak hesaplanm\u0131\u015ft\u0131r.<\/p>

                                                Bu risk gebeli\u011fin devam etti\u011fi her hafta yakla\u015f\u0131k iki kat artmakta ve gebelik sonunda %8\u2019e kadar ula\u015fabilmektedir.<\/p>

                                                \"\"

                                                Normal fet\u00fcslerde ve fetal b\u00fcy\u00fcme k\u0131s\u0131tl\u0131l\u0131\u011f\u0131 olan fet\u00fcslerde Doppler bulgular\u0131<\/p><\/div>

                                                Erken Ba\u015flang\u0131\u00e7l\u0131 B\u00fcy\u00fcme Gerili\u011finde Doppler Bulgular\u0131n\u0131n K\u00f6t\u00fcle\u015fme S\u0131ras\u0131<\/h4>

                                                Erken ba\u015flang\u0131\u00e7l\u0131 FGR’de k\u00f6t\u00fcle\u015fme Doppler ultrasonografi ile izlenir.<\/p>

                                                Umbilikal arter direnci, kardiyovask\u00fcler ve metabolik bozulmadan haftalar \u00f6nce y\u00fckselmeye ba\u015flar.<\/p>

                                                Tipik ilerleme \u015f\u00f6yledir:<\/p>

                                                1. Umbilikal arter PI art\u0131\u015f\u0131<\/li>
                                                2. Diyastol sonu ak\u0131m\u0131n kaybolmas\u0131 (AEDF)<\/li>
                                                3. Diyastol sonu ak\u0131m\u0131n tersine d\u00f6nmesi (REDF)<\/li>
                                                4. Duktus venozus de\u011fi\u015fiklikleri<\/li>
                                                5. Duktus venozusta a-dalgas\u0131n\u0131n kaybolmas\u0131 veya ters d\u00f6nmesi<\/li>
                                                6. \u015eiddetli fetal hipoksi<\/li>
                                                7. KTG\u2019de deselerasyonlar<\/li>
                                                8. Anormal biyofizik profil<\/li>
                                                9. Yakla\u015f\u0131k bir hafta i\u00e7inde intrauterin \u00f6l\u00fcm (%40\u201370)<\/li><\/ol>

                                                  Normal ve B\u00fcy\u00fcme Gerili\u011fi Olan Fet\u00fcslerde Doppler Bulgular\u0131<\/h4>

                                                  Ge\u00e7 ba\u015flang\u0131\u00e7l\u0131 b\u00fcy\u00fcme gerili\u011finde bozulma daha hafiftir ve \u015fu \u00f6zelliklerle karakterizedir:<\/p>

                                                  • Umbilikal arter PI de\u011ferinde hafif art\u0131\u015f<\/li>
                                                  • Orta serebral arter PI de\u011ferinde azalma<\/li>
                                                  • Serebroplasental oran (CPR) de\u011ferinde d\u00fc\u015fme<\/li><\/ul>

                                                    .<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

                                                    \n\t\t\t\t\t
                                                    \n\t\t\t\t
                                                    \n\t\t\t\t\t\t\t\t\t

                                                    B\u00fcy\u00fcme Gerili\u011fi Olan Fet\u00fcslerde Do\u011fum Zamanlamas\u0131<\/h4>

                                                    2005\u20132010 y\u0131llar\u0131 aras\u0131nda 20 Avrupa merkezinde ger\u00e7ekle\u015ftirilen TRUFFLE \u00c7al\u0131\u015fmas\u0131<\/strong>, erken ba\u015flang\u0131\u00e7l\u0131 b\u00fcy\u00fcme gerili\u011finde do\u011fum zaman\u0131n\u0131n Doppler ve KTG bulgular\u0131na g\u00f6re belirlenmesini \u00f6nermi\u015ftir.<\/p>

                                                    Bu \u00e7al\u0131\u015fma temel al\u0131narak:<\/p>

                                                    • SMFM (Society for Maternal-Fetal Medicine)<\/li>
                                                    • ISUOG (International Society of Ultrasound in Obstetrics and Gynecology)<\/li><\/ul>

                                                      a\u015fa\u011f\u0131daki \u00f6nerileri yay\u0131nlam\u0131\u015ft\u0131r.<\/p>

                                                      Bir sonraki b\u00f6l\u00fcmde:<\/p>

                                                      • Erken ba\u015flang\u0131\u00e7l\u0131 FGR i\u00e7in SMFM\u2013ISUOG do\u011fum \u00f6nerileri<\/strong><\/li>
                                                      • AEDF ve REDF olgular\u0131n\u0131n y\u00f6netimi<\/strong><\/li>
                                                      • Kortikosteroid ve magnezyum s\u00fclfat kullan\u0131m\u0131<\/strong><\/li>
                                                      • Ge\u00e7 ba\u015flang\u0131\u00e7l\u0131 FGR ve SGA izlemi<\/strong><\/li>
                                                      • Sonu\u00e7 ve klinik \u00f6neriler<\/strong><\/li><\/ul>

                                                        Erken Ba\u015flang\u0131\u00e7l\u0131 Fetal B\u00fcy\u00fcme K\u0131s\u0131tl\u0131l\u0131\u011f\u0131nda (FGR) Do\u011fum Zamanlamas\u0131<\/h4>

                                                        Umbilikal Arterde Ters Diyastol Sonu Ak\u0131m (REDF)<\/h4>

                                                        Umbilikal arterde diyastol sonu ak\u0131m\u0131n tersine d\u00f6nmesi (REDF) saptanan fet\u00fcslerde do\u011fumun 30\u201332. gebelik haftas\u0131ndan sonra geciktirilmemesi<\/strong> \u00f6nerilir.<\/p>

                                                        Do\u011fum \u00f6ncesinde a\u015fa\u011f\u0131daki tedaviler uygulanmal\u0131d\u0131r:<\/p>

                                                        Kortikosteroidler<\/h4>

                                                        Kortikosteroid uygulamas\u0131:<\/p>

                                                        • Respiratuvar distres sendromu riskini %29,<\/li>
                                                        • \u0130ntraventrik\u00fcler kanama riskini %42,<\/li>
                                                        • \u0130ntrauterin \u00f6l\u00fcm riskini %22<\/li><\/ul>

                                                          oran\u0131nda azaltmaktad\u0131r.<\/p>

                                                          Magnezyum S\u00fclfat<\/h4>

                                                          Magnezyum s\u00fclfat uygulanmas\u0131:<\/p>

                                                          • Serebral palsi riskini %32 oran\u0131nda azaltmaktad\u0131r.<\/li><\/ul>

                                                            Bu olgularda takip tercihen hastanede yap\u0131lmal\u0131d\u0131r:<\/p>

                                                            • G\u00fcnl\u00fck Doppler ultrasonografi<\/li>
                                                            • G\u00fcnde 1\u20132 kez kardiyotokografi (KTG)<\/li><\/ul>

                                                              Umbilikal Arterde Diyastol Sonu Ak\u0131m\u0131n Kaybolmas\u0131 (AEDF)<\/h4>

                                                              AEDF bulunan fet\u00fcslerde do\u011fumun 33\u201334. gebelik haftas\u0131ndan sonra geciktirilmemesi<\/strong> \u00f6nerilir.<\/p>

                                                              Bu olgularda:<\/p>

                                                              • Antenatal kortikosteroid uygulanmal\u0131d\u0131r.<\/li>
                                                              • Doppler incelemesi haftada 2\u20133 kez yap\u0131lmal\u0131d\u0131r.<\/li>
                                                              • KTG haftada 2 kez uygulanmal\u0131d\u0131r.<\/li><\/ul>

                                                                Takip uygun olgularda ayaktan ger\u00e7ekle\u015ftirilebilir.<\/p>

                                                                Duktus Venozusta a-Dalgas\u0131n\u0131n Kaybolmas\u0131 veya Tersine D\u00f6nmesi<\/h4>

                                                                Duktus venozusta a-dalgas\u0131n\u0131n kaybolmas\u0131 ya da ters ak\u0131m g\u00f6r\u00fclmesi, fetal kardiyovask\u00fcler dekompansasyonun ileri bir g\u00f6stergesidir.<\/p>

                                                                Bu durumda:<\/p>

                                                                • Tahmini fetal a\u011f\u0131rl\u0131k 500 gram\u0131n \u00fczerindeyse,<\/li>
                                                                • Kortikosteroid ve magnezyum s\u00fclfat uygulanm\u0131\u015fsa,<\/li><\/ul>

                                                                  do\u011fumun 26\u201332. gebelik haftalar\u0131 aras\u0131nda ger\u00e7ekle\u015ftirilmesi<\/strong> \u00f6nerilmektedir.<\/p>

                                                                  Umbilikal Arter PI Art\u0131\u015f\u0131<\/h4>

                                                                  Umbilikal arter PI de\u011ferinin artm\u0131\u015f oldu\u011fu ancak AEDF veya REDF bulunmad\u0131\u011f\u0131 olgularda:<\/p>

                                                                  • Do\u011fum 37. haftada ger\u00e7ekle\u015ftirilebilir.<\/li>
                                                                  • Haftal\u0131k Doppler incelemesi yap\u0131lmal\u0131d\u0131r.<\/li>
                                                                  • KTG haftada 1\u20132 kez uygulanmal\u0131d\u0131r<\/li><\/ul>

                                                                    \"\"Different types fetal growth restriction in comparison to normal<\/p>

                                                                    Ge\u00e7 Ba\u015flang\u0131\u00e7l\u0131 FGR ve SGA Fet\u00fcslerin Takibi<\/h4>

                                                                    3.\u201310. Persentil Aras\u0131nda ve Normal Doppler Bulgular\u0131 (SGA)<\/p>

                                                                    Tahmini fetal a\u011f\u0131rl\u0131k:<\/p>

                                                                    • 3.\u201310. persentiller aras\u0131nda<\/li>
                                                                    • Doppler incelemesi normal<\/li><\/ul>

                                                                      ise fet\u00fcs gebelik haftas\u0131na g\u00f6re k\u00fc\u00e7\u00fck (SGA)<\/strong> olarak kabul edilir.<\/p>

                                                                      Takip<\/h4>
                                                                      • Doppler incelemesi her 1\u20132 haftada bir<\/li>
                                                                      • Bulgular stabil ise her 2\u20134 haftada bir<\/li>
                                                                      • Haftal\u0131k KTG<\/li>
                                                                      • Fetal a\u011f\u0131rl\u0131k tahmini her 3\u20134 haftada bir<\/li><\/ul>

                                                                        Do\u011fum Zaman\u0131<\/h4>

                                                                        38\u201339. gebelik haftalar\u0131 aras\u0131nda do\u011fum planlanabilir.<\/p>

                                                                        3. Persentilin Alt\u0131nda veya Anormal Doppler Bulgular\u0131 Olan Fet\u00fcsler<\/h4>

                                                                        A\u015fa\u011f\u0131daki durumlar FGR lehine de\u011ferlendirilir:<\/p>

                                                                        • Tahmini fetal a\u011f\u0131rl\u0131\u011f\u0131n 3. persentilin alt\u0131nda olmas\u0131<\/li>
                                                                        • Tahmini fetal a\u011f\u0131rl\u0131\u011f\u0131n 3.\u201310. persentiller aras\u0131nda olup anormal Doppler bulgular\u0131 g\u00f6stermesi<\/li><\/ul>

                                                                          \u00d6rne\u011fin:<\/p>

                                                                          • CPR < 5. persentil<\/li>
                                                                          • Uterin arter PI > 95. persentil<\/li><\/ul>

                                                                            Takip<\/h4>
                                                                            • Haftal\u0131k Doppler ultrasonografi<\/li>
                                                                            • Haftal\u0131k KTG<\/li>
                                                                            • Her 2 haftada bir fetal a\u011f\u0131rl\u0131k hesaplamas\u0131<\/li><\/ul>

                                                                              Do\u011fum Zaman\u0131<\/h4>
                                                                              1. gebelik haftas\u0131nda do\u011fum \u00f6nerilir.<\/li><\/ol>

                                                                                \u00a0<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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                                                                                • Sonu\u00e7lar<\/h4>

                                                                                  A\u015fa\u011f\u0131daki sonu\u00e7lara ula\u015f\u0131labilir:<\/p>

                                                                                  Yap\u0131sal Olarak K\u00fc\u00e7\u00fck Fet\u00fcsler (SGA)<\/p>

                                                                                  Ard\u0131\u015f\u0131k ultrasonografilerde:<\/p>

                                                                                  • Tahmini fetal a\u011f\u0131rl\u0131k 3.\u201310. persentiller aras\u0131nda,<\/li>
                                                                                  • Fetal damar Doppler incelemeleri normal,<\/li>
                                                                                  • Anatomik anomali bulunmayan<\/li><\/ul>

                                                                                    fet\u00fcsler konstit\u00fcsyonel olarak k\u00fc\u00e7\u00fck (SGA)<\/strong> kabul edilir.<\/p>

                                                                                    Bu fet\u00fcslerin prognozu genellikle iyidir; ancak d\u00fczenli takip gereklidir.<\/p><\/li>

                                                                                  • Fetal B\u00fcy\u00fcme K\u0131s\u0131tl\u0131l\u0131\u011f\u0131 (FGR)<\/p>

                                                                                    A\u015fa\u011f\u0131daki fet\u00fcsler FGR olarak de\u011ferlendirilir:<\/p>

                                                                                    • Tahmini fetal a\u011f\u0131rl\u0131k 3. persentilin alt\u0131nda olanlar<\/li>
                                                                                    • Tahmini fetal a\u011f\u0131rl\u0131k 3.\u201310. persentiller aras\u0131nda olup Doppler bulgular\u0131 anormal olanlar<\/li><\/ul>

                                                                                      Bu fet\u00fcsler artm\u0131\u015f risk alt\u0131ndad\u0131r.<\/p>

                                                                                      Genetik \u0130nceleme Endikasyonlar\u0131<\/p>

                                                                                      B\u00fcy\u00fcme gerili\u011fi:<\/p>

                                                                                      24 Haftadan \u00d6nce Ba\u015flarsa<\/p>

                                                                                      Anatomik anomali bulunmasa bile:<\/p>

                                                                                      • Amniyosentez yap\u0131lmal\u0131,<\/li>
                                                                                      • Kromozomal anomaliler ara\u015ft\u0131r\u0131lmal\u0131d\u0131r.<\/li><\/ul>

                                                                                        24\u201332 Haftalar Aras\u0131nda Ba\u015flarsa<\/p>

                                                                                        Genetik inceleme \u00f6zellikle:<\/p>

                                                                                        • Yap\u0131sal anomaliler mevcutsa<\/li>
                                                                                        • Hafif anomaliler bile varsa (\u00f6rne\u011fin polihidramniyos)<\/li><\/ul>

                                                                                          \u00f6nerilmektedir.<\/p>

                                                                                          Do\u011fum Sonras\u0131 De\u011ferlendirme<\/p>

                                                                                          B\u00fcy\u00fcme gerili\u011fi ile do\u011fan yenido\u011fanlarda prenatal tan\u0131sal incelemeler yap\u0131lmam\u0131\u015fsa:<\/p>

                                                                                          • Ayr\u0131nt\u0131l\u0131 fizik muayene<\/li>
                                                                                          • Fenotipik de\u011ferlendirme<\/li>
                                                                                          • Klinik genetik inceleme<\/li><\/ul>

                                                                                            ger\u00e7ekle\u015ftirilmelidir.<\/p>

                                                                                            Fetal veya neonatal kay\u0131p durumlar\u0131nda ise:<\/p>

                                                                                            • Otopsi<\/li>
                                                                                            • Plasenta incelemesi<\/li>
                                                                                            • Genetik de\u011ferlendirme<\/li><\/ul>

                                                                                              altta yatan nedenin belirlenmesi ve gelecekteki gebelikler i\u00e7in do\u011fru dan\u0131\u015fmanl\u0131k verilmesi a\u00e7\u0131s\u0131ndan b\u00fcy\u00fck \u00f6nem ta\u015f\u0131maktad\u0131r.<\/p><\/li><\/ul>

                                                                                              Bibliography:<\/strong><\/p>

                                                                                              1. Grati FR, Malvestiti F, Branca L, et al. Chromosomal mosaicism in thefetoplacental unit. Best Pract Res Clin Obstet Gynaecol. 2017 Jul;42:39-52<\/em><\/li>
                                                                                              2. Peng R, Yang J, Xie HN, et al. Chromosomal and subchromosomal anomalies associated to small for gestational age fetuses with no additional structural anomalies. Prenat Diagn. 2017 Dec;37(12):1219-1224<\/em><\/li>
                                                                                              3. Zhu H, Lin S, Huang L, et al. Application of chromosomal microarray analysis in prenatal diagnosis of fetal growth restriction. Prenat Diagn. 2016 Jul;36(7):686-692<\/em><\/li>
                                                                                              4. van Wyk L, Boers KE, van der Post JA, et al. Effects on (neuro) developmental and behavioral outcome at 2 years of age of induced labor compared with expectant management in intrauterine growth-restricted infants: long-term outcomes of the DIGITAT trial. Am J Obstet Gynecol 2012;206:406.e1\u20137.<\/span><\/em><\/li>
                                                                                              5. Society for Maternal-Fetal Medicine Consult Series #52: Diagnosis and management of fetal growth restriction: (Replaces Clinical Guideline Number 3, April 2012)Am J Obstet Gynecol. 2020 Oct;223(4):B2-B17.<\/span> Epub 2020 May 12.<\/span><\/em><\/li><\/ol>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

                                                                                                Tan\u0131m K\u00fc\u00e7\u00fck fet\u00fcs (Small for Gestational Age – SGA), ultrasonografik incelemede tahmini fetal a\u011f\u0131rl\u0131\u011f\u0131 10. persentilin alt\u0131nda olan fet\u00fcs olarak tan\u0131mlan\u0131r. Bu grup t\u00fcm fet\u00fcslerin yakla\u015f\u0131k [\u2026]<\/span><\/p>\n","protected":false},"author":3,"featured_media":-1,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[117,79],"tags":[115],"class_list":["post-1632","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-genetik","category-obstetrik","tag-kucuk-fetus"],"yoast_head":"\nK\u00fc\u00e7\u00fck fet\u00fcs - \u0391\u03bb\u03ad\u03be\u03b1\u03bd\u03b4\u03c1\u03bf\u03c2 \u039c\u03ac\u03b9\u03bd\u03b1\u03c2 MD, PhD<\/title>\n<meta name=\"description\" content=\"K\u00fc\u00e7\u00fck fet\u00fcs (Small for Gestational Age - SGA), ultrasonografik incelemede tahmini fetal a\u011f\u0131rl\u0131\u011f\u0131 10. persentilin alt\u0131nda olan fet\u00fcs olarak tan\u0131mlan\u0131r. 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