{"id":2725,"date":"2024-09-25T00:00:00","date_gmt":"2024-09-24T21:00:00","guid":{"rendered":"https:\/\/gynaikologos-komotini.gr\/?p=2725"},"modified":"2026-11-01T14:39:16","modified_gmt":"2026-11-01T12:39:16","slug":"ikiz-gebelik-epidemiyoloji-ve-olusum-mekanizmalari-2","status":"publish","type":"post","link":"https:\/\/gynaikologos-komotini.gr\/tr\/ikiz-gebelik-epidemiyoloji-ve-olusum-mekanizmalari-2\/","title":{"rendered":"\u0130kiz Gebelik: Epidemiyoloji ve Olu\u015fum Mekanizmalar\u0131"},"content":{"rendered":"\t\t
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Giri\u015f<\/h4>

\u00c7o\u011ful gebelikler, d\u00fcnya genelindeki t\u00fcm gebeliklerin yakla\u015f\u0131k %1\u20133’\u00fcn\u00fc olu\u015fturmakta olup, bunlar\u0131n %98’i ikiz gebeliklerden meydana gelmektedir. Bununla birlikte, ikiz gebeliklerin g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 d\u00fcnyan\u0131n farkl\u0131 co\u011frafi b\u00f6lgelerinde ayn\u0131 de\u011fildir.<\/p>

En y\u00fcksek g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 Sahra Alt\u0131 Afrika’da (%1,8), en d\u00fc\u015f\u00fck g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 ise Bat\u0131 ve G\u00fcneybat\u0131 Asya’da (%0,6) bildirilmektedir. Avrupa, Kuzey Amerika ve G\u00fcney Asya’da ise bu oranlar ara d\u00fczeydedir.<\/p>

\u0130kiz gebeliklerin genel g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 co\u011frafi b\u00f6lgelere g\u00f6re de\u011fi\u015fiklik g\u00f6sterse de, monozigotik ikiz gebeliklerin g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131<\/strong> b\u00fcy\u00fck \u00f6l\u00e7\u00fcde sabit kalmaktad\u0131r. Bununla birlikte, yard\u0131mc\u0131 \u00fcreme tekniklerinin (Y\u00dcT) uygulanmas\u0131yla, \u00f6zellikle d\u00f6llenme s\u00fcrecinde mikromanip\u00fclasyon i\u015flemlerine maruz kalm\u0131\u015f blastokistlerin transfer edilmesi durumunda, monozigotik ikiz gebelik oran\u0131nda hafif bir art\u0131\u015f g\u00f6zlenmektedir.\"\"<\/p>

Yunanistan’da 2000 y\u0131l\u0131ndan itibaren, di\u011fer geli\u015fmi\u015f \u00fclkelerle kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda ikiz gebelik oranlar\u0131nda dikkat \u00e7ekici bir art\u0131\u015f meydana gelmi\u015ftir. Bu art\u0131\u015f\u0131n ba\u015fl\u0131ca nedeni yard\u0131mc\u0131 \u00fcreme tekniklerinin yayg\u0131n olarak uygulanmas\u0131d\u0131r. S\u00f6z konusu durum, ilgili denetleyici ve d\u00fczenleyici kurumlar taraf\u0131ndan dikkatle de\u011ferlendirilmelidir.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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\u0130kiz Gebelik Nas\u0131l Olu\u015fur?<\/h4>

\u0130kiz gebelikler iki farkl\u0131 mekanizma sonucunda olu\u015fabilir.<\/p>

Birinci mekanizmada, iki ayr\u0131 oositin d\u00f6llenmesi sonucunda iki zigot ve genetik olarak birbirinden farkl\u0131 iki embriyo meydana gelir. Her embriyo kendi amniyon kesesi i\u00e7erisinde geli\u015fir ve ayr\u0131 bir plasentaya sahiptir. Bu durum dikoryonik diamniyotik dizigotik ikiz gebelik<\/strong> olarak adland\u0131r\u0131l\u0131r.<\/p>

\u0130kinci mekanizmada ise tek bir oositin d\u00f6llenmesi sonucunda bir zigot olu\u015fur ve bu zigot daha sonra b\u00f6l\u00fcnerek ikiz embriyolar\u0131n geli\u015fmesine yol a\u00e7ar.<\/p>

Bu durumda embriyonik b\u00f6l\u00fcnmenin ger\u00e7ekle\u015fti\u011fi zamana ba\u011fl\u0131 olarak farkl\u0131 ikiz gebelik tipleri ortaya \u00e7\u0131kabilir. Geleneksel olarak bu gebeliklerin ortak \u00f6zelli\u011fi, embriyolar\u0131n esas olarak ayn\u0131 genetik materyali payla\u015fmas\u0131d\u0131r (monozigotik ikiz gebelik<\/strong><\/a>).<\/p>

Klasik embriyolojik modele g\u00f6re, b\u00f6l\u00fcnme \u00e7ok erken d\u00f6nemde, zigot a\u015famas\u0131nda ve d\u00f6llenmeden sonraki \u00fc\u00e7\u00fcnc\u00fc g\u00fcne kadar ger\u00e7ekle\u015firse, iki ayr\u0131 amniyon kesesi ve iki ayr\u0131 plasenta olu\u015fur. Bu gebelik tipi dikoryonik diamniyotik monozigotik ikiz gebelik<\/strong> olarak tan\u0131mlan\u0131r.\"\"<\/p>

\u015eekil: Embriyonik geli\u015fim ve embriyonik b\u00f6l\u00fcnmenin ger\u00e7ekle\u015fti\u011fi zamana g\u00f6re olu\u015fan ikiz gebelik tipleri.<\/em><\/p>

Bununla birlikte, b\u00f6l\u00fcnme \u00e7o\u011funlukla \u00fc\u00e7\u00fcnc\u00fc ve sekizinci g\u00fcnler aras\u0131nda, \u00f6zellikle erken blastokist a\u015famas\u0131nda (yakla\u015f\u0131k be\u015finci g\u00fcn) meydana gelir. Bu durumda iki ayr\u0131 amniyon kesesi bulunmas\u0131na ra\u011fmen embriyolar tek bir plasentay\u0131 payla\u015f\u0131r. Bu gebelik tipi monokoryonik diamniyotik ikiz gebelik<\/strong><\/a> olarak adland\u0131r\u0131l\u0131r.<\/p>

B\u00f6l\u00fcnmenin sekizinci g\u00fcnden sonra ger\u00e7ekle\u015fmesi durumunda, ikizler hem ayn\u0131 amniyon kesesini hem de ayn\u0131 plasentay\u0131 payla\u015f\u0131r. Bu durum monokoryonik monoamniyotik ikiz gebelik<\/strong> olarak tan\u0131mlan\u0131r.<\/p>

B\u00f6l\u00fcnme on ikinci g\u00fcnden sonra ger\u00e7ekle\u015fir ve tamamlanamazsa, v\u00fccutlar\u0131n\u0131n farkl\u0131 anatomik b\u00f6lgelerinden birbirine ba\u011fl\u0131 olan yap\u0131\u015f\u0131k ikizler (Siyam ikizleri)<\/strong> geli\u015febilir.<\/p>

Koryonisite<\/strong>, plasentan\u0131n damar yap\u0131s\u0131n\u0131 ve fetal hemodinami\u011fi belirledi\u011finden, ikiz gebeli\u011fin nihai sonucunu etkileyen en \u00f6nemli klinik fakt\u00f6rd\u00fcr.<\/p>

Son y\u0131llarda, monozigotik ikizlerin genetik olarak tamamen ayn\u0131 oldu\u011fu y\u00f6n\u00fcndeki geleneksel g\u00f6r\u00fc\u015f giderek daha fazla sorgulanmaktad\u0131r.<\/p>

Monozigotik ikizler aras\u0131nda farkl\u0131 mutasyonlar, mozaiklik ve epigenetik s\u00fcre\u00e7ler saptanm\u0131\u015f olup, bu mekanizmalar ikizler aras\u0131nda genetik ve fenotipik farkl\u0131l\u0131klar\u0131n ortaya \u00e7\u0131kmas\u0131na neden olabilmektedir.<\/p>

Nadir durumlarda, erken embriyonik h\u00fccre b\u00f6l\u00fcnmesi s\u0131ras\u0131nda cinsiyet kromozomlar\u0131n\u0131 etkileyen anomalilerle ili\u015fkili olabilen fenotipik cinsiyet farkl\u0131l\u0131klar\u0131<\/strong> da bildirilmi\u015ftir.<\/p>

\u00dc\u00e7\u00fcnc\u00fc g\u00fcnden sonra meydana gelen embriyonik b\u00f6l\u00fcnmenin monokoryonik monozigotik ikizlerle sonu\u00e7lanmas\u0131n\u0131n beklendi\u011fi klasik ikiz olu\u015fum modeli, g\u00f6zlenen t\u00fcm vakalar\u0131 a\u00e7\u0131klamakta yetersiz kalmaktad\u0131r.<\/p>

\u00d6rne\u011fin, d\u00f6rd\u00fcnc\u00fc veya be\u015finci g\u00fcn embriyosunun tek ba\u015f\u0131na transfer edilmesinden sonra meydana gelebilecek herhangi bir b\u00f6l\u00fcnmenin, geleneksel modele g\u00f6re tek bir plasentay\u0131 payla\u015fan monokoryonik monozigotik ikizlerle sonu\u00e7lanmas\u0131 beklenir.<\/p>

Ancak klinik g\u00f6zlemler bunun her zaman ge\u00e7erli olmad\u0131\u011f\u0131n\u0131 g\u00f6stermektedir. Tek embriyo transferinden sonra dikoryonik ikiz gebelikler ve hatta dizigotik ikizlerin bildirildi\u011fi vakalar bulunmaktad\u0131r.\"\"<\/p>

Bu bulgular, plasental yap\u0131n\u0131n tek ba\u015f\u0131na embriyonik k\u00f6kenin belirlenmesi i\u00e7in yeterli olmad\u0131\u011f\u0131n\u0131<\/strong> ve monozigotik ikizlerin olu\u015fumunda yaln\u0131zca zigotun b\u00f6l\u00fcnme zaman\u0131n\u0131n de\u011fil, birden fazla geli\u015fimsel mekanizman\u0131n rol oynayabilece\u011fini<\/strong> d\u00fc\u015f\u00fcnd\u00fcrmektedir.<\/p>

Spontan olarak olu\u015fan dikoryonik diamniyotik (DKDA) ikiz gebelikler, t\u00fcm gebeliklerin yakla\u015f\u0131k 1\/100’\u00fcn\u00fc olu\u015ftururken, monokoryonik diamniyotik (MKDA) ikiz gebelikler t\u00fcm ikiz gebeliklerin yakla\u015f\u0131k \u00fc\u00e7te birini olu\u015fturmakta ve genel gebelikler i\u00e7erisindeki s\u0131kl\u0131klar\u0131 yakla\u015f\u0131k 1\/300 olarak bildirilmektedir.<\/p>

MKDA gebeliklerin g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131, yard\u0131mc\u0131 \u00fcreme teknikleri (IVF) sonras\u0131nda yakla\u015f\u0131k 1\/50’ye<\/strong>, ovulasyon ind\u00fcksiyonu sonras\u0131nda ise 1\/25’e<\/strong> y\u00fckselmektedir.<\/p>

Son olarak, spontan olarak olu\u015fan monozigotik ikiz gebeliklerin yakla\u015f\u0131k %65’i monokoryonik<\/strong>, %35’i ise dikoryoniktir<\/strong>.<\/p>

Yard\u0131mc\u0131 \u00fcreme tekniklerinin uygulanmas\u0131ndan sonra monozigotik ikiz gebelikler i\u00e7erisindeki monokoryonik gebelik oran\u0131 yakla\u015f\u0131k %80’e<\/strong> y\u00fckselmektedir.<\/p>

Bu durum, tek embriyo transferinden sonra olu\u015fan gebeliklerin yakla\u015f\u0131k %1,5\u20132’sinin monozigotik ikiz gebelikle<\/strong>, \u00e7o\u011funlukla da monokoryonik plasentasyonla sonu\u00e7lanabilece\u011fini g\u00f6stermektedir.<\/p>

Sonu\u00e7 olarak, dizigotik ikiz gebelikler ailesel yatk\u0131nl\u0131k g\u00f6sterirken<\/strong>, monozigotik ikiz gebelikler genellikle sporadik olarak ortaya \u00e7\u0131kmakta ve g\u00f6r\u00fclme s\u0131kl\u0131klar\u0131 \u00f6zellikle yard\u0131mc\u0131 \u00fcreme tekniklerinin uygulanmas\u0131yla artmaktad\u0131r.<\/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\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

Giri\u015f \u00c7o\u011ful gebelikler, d\u00fcnya genelindeki t\u00fcm gebeliklerin yakla\u015f\u0131k %1\u20133’\u00fcn\u00fc olu\u015fturmakta olup, bunlar\u0131n %98’i ikiz gebeliklerden meydana gelmektedir. Bununla birlikte, ikiz gebeliklerin g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 d\u00fcnyan\u0131n farkl\u0131 co\u011frafi [\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":[120,79],"tags":[],"class_list":["post-2725","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ikiz-gebelik","category-obstetrik"],"yoast_head":"\n\u0130kiz Gebelik: Epidemiyoloji ve Olu\u015fum Mekanizmalar\u0131 - \u0391\u03bb\u03ad\u03be\u03b1\u03bd\u03b4\u03c1\u03bf\u03c2 \u039c\u03ac\u03b9\u03bd\u03b1\u03c2 MD, PhD<\/title>\n<meta name=\"description\" content=\"\u00c7o\u011ful gebelikler, d\u00fcnya genelindeki t\u00fcm gebeliklerin yakla\u015f\u0131k %1\u20133'\u00fcn\u00fc olu\u015fturmakta olup, bunlar\u0131n 'i ikiz gebeliklerden meydana gelmektedir. 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