{"id":9061,"date":"2017-10-31T09:46:02","date_gmt":"2017-10-31T07:46:02","guid":{"rendered":"https:\/\/gynaikologos-komotini.gr\/hamile\/mi-epemvatikos-progennitikos-elegchos\/"},"modified":"2023-05-02T14:06:10","modified_gmt":"2023-05-02T12:06:10","slug":"non-invaziv-prenatal-tarama","status":"publish","type":"page","link":"https:\/\/gynaikologos-komotini-old.xo-websites4.gr\/tr\/hamile\/non-invaziv-prenatal-tarama\/","title":{"rendered":"Non invaziv prenatal tarama"},"content":{"rendered":"

\u039c\u03b7 \u03b5\u03c0\u03b5\u03bc\u03b2\u03b5\u03c4\u03b9\u03ba\u03cc\u03c2 \u03c0\u03c1\u03bf\u03b3\u03b5\u03bd\u03bd\u03b7\u03c4\u03b9\u03ba\u03cc\u03c2 \u03ad\u03bb\u03b5\u03b3\u03c7\u03bf\u03c2<\/h2>\n

\u039c\u03b7 \u03b5\u03c0\u03b5\u03bc\u03b2\u03b5\u03c4\u03b9\u03ba\u03cc\u03c2 \u03c0\u03c1\u03bf\u03b3\u03b5\u03bd\u03bd\u03b7\u03c4\u03b9\u03ba\u03cc\u03c2 \u03ad\u03bb\u03b5\u03b3\u03c7\u03bf\u03c2<\/h3>\n

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\"xrwmosomikes-anwmalies\"<\/a><\/div><\/div>\n

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\u015eimdiye kadar ne yap\u0131yoruz?<\/strong><\/h4>\n

Fet\u00fcslerde en s\u0131k g\u00f6r\u00fclen kromozom anomalisi trizomi 21 veya Down sendromudur, daha az s\u0131kl\u0131kta trizomi 18 ve 13 g\u00f6r\u00fcl\u00fcr ve bunlar do\u011frudan annenin ya\u015f\u0131 ile ili\u015fkilidir. Te\u015fhisleri, fet\u00fcs\u00fcn ultrason muayenesi<\/strong> (ense saydaml\u0131\u011f\u0131) ve annenin biyokimyasal belirte\u00e7lerini i\u00e7eren kombine bir do\u011fum \u00f6ncesi testi uygulanarak ger\u00e7ekle\u015ftirilir, b\u00f6ylece ortaya \u00e7\u0131kacak olas\u0131l\u0131\u011fa ba\u011fl\u0131 olarak, invaziv prenatal tarama metodu<\/strong> uygulanmas\u0131 i\u00e7in y\u00fcksek riskli gebeler se\u00e7ilebilir. Bu t\u00fcr bir uygulama, %1,3 hata olas\u0131l\u0131\u011f\u0131 ile (yanl\u0131\u015f pozitif sonu\u00e7lar)\u00a0 trizomi 21’in %93’\u00fcn\u00fc ve trizomi 18 ve 13’\u00fcn %95’ini saptar.<\/div><\/div>\n

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Yeni y\u00f6ntem nedir?<\/strong><\/h4>\n

Bununla birlikte, plasenta kaynakl\u0131 fet\u00fcs\u00fcn DNA b\u00f6l\u00fcmlerinin anne kan\u0131nda yeterli miktarlarda (gebeli\u011fin 10. haftas\u0131ndan sonra) serbest\u00e7e dola\u015ft\u0131\u011f\u0131n\u0131n ke\u015ffedilmesi, DNA dizisinin kitlesel veya se\u00e7ici belirleme teknikleri yoluyla (MPSS, CSS, SNP) kromozomlar\u0131n, normale g\u00f6re daha fazla veya daha az kopyalar\u0131n\u0131n olup olmad\u0131\u011f\u0131n\u0131 belirleme olas\u0131l\u0131\u011f\u0131n\u0131 sunmu\u015ftur. Bu y\u00f6nteme non-invaziv prenatal serbest DNA testi (cfDNA testi veya NIPT)<\/strong> ad\u0131 verilir ve yak\u0131n tarihli bir ara\u015ft\u0131rmaya g\u00f6re g\u00fcvenilirli\u011fi trizomi 21 i\u00e7in %99,5 ve trizomi 18 ve 13 i\u00e7in s\u0131ras\u0131yla %96 ve %91’dir. Trizomi 21 i\u00e7in hata olas\u0131l\u0131\u011f\u0131 %0,08 ve geri kalan\u0131 i\u00e7in %0,26d\u0131r. \u0130kiz gebeliklerde trizomi 21 i\u00e7in g\u00fcvenilirlik %93.7, hata olas\u0131l\u0131\u011f\u0131 %0.23’t\u00fcr.<\/p>\n

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<\/div>\n\"xrwmoswmata-1\"<\/a><\/div>\n
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<\/div>\n\"parakolouthisi-glikozis-sto-aima\"<\/a><\/div>\n
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Ne zaman?<\/strong><\/h4>\n

CfDNA testi elbette tan\u0131sal de\u011fildir, ancak prognostiktir, bu nedenle y\u00fcksek risk ta\u015f\u0131yan kad\u0131nlar sonunda tan\u0131y\u0131 do\u011frulamak i\u00e7in invaziv bir teste tabi tutulur. Kullan\u0131lan tekniklerden MPSS en d\u00fc\u015f\u00fck ba\u015far\u0131s\u0131zl\u0131k oran\u0131na sahiptir ve sonu\u00e7 i\u00e7in gereken s\u00fcre 5-10 g\u00fcn aras\u0131nda de\u011fi\u015fmektedir.<\/div><\/div>\n

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Nerede?<\/strong><\/h4>\n

Laboratuvarlar\u0131 a\u011f\u0131rl\u0131kl\u0131 olarak Amerika’da bulunan testi sunan bir\u00e7ok \u015firket var. Avrupa’da, sonucun g\u00fcvenilirli\u011fini garanti eden \u00f6nemli Avrupa sertifikalar\u0131na sahip tek laboratuvar \u0130svi\u00e7re’de bulunmaktad\u0131r.<\/p>\n

\"181407-cfDNA_1\"<\/a><\/div>\n

Ultrason ve non-invaziv prenatal test kar\u015f\u0131la\u015ft\u0131rmas\u0131<\/strong><\/h4>\n

\u0130ki y\u00f6ntem kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda, NIPT’\u0131n g\u00fcvenilirlik a\u00e7\u0131s\u0131ndan klasik ultrason kontrol\u00fcnden daha \u00fcst\u00fcn oldu\u011fu a\u00e7\u0131kt\u0131r, ancak maliyeti ve d\u00fc\u015f\u00fckte olsa kesin bir sonu\u00e7 vermeme ihtimali (% 1-5), \u015fu anda t\u00fcm kad\u0131nlarda uygulanmas\u0131na izin vermemektedir.<\/div>\n

Hangi kad\u0131nlara NIPT yap\u0131lmal\u0131?<\/strong><\/h4>\n

\u00d6nerilen en iyi strateji, ba\u015flang\u0131\u00e7ta, fet\u00fcs\u00fcn anatomisi, preeklampsi ve b\u00fcy\u00fcme gerili\u011fi olas\u0131l\u0131\u011f\u0131n\u0131n belirlenmesi hakk\u0131nda bize \u00f6nemli ek bilgiler veren klasik ultrason muayenesini biyokimyasal belirte\u00e7lerle birlikte yapmakt\u0131r. Riskin y\u00fcksek oldu\u011fu durumlarda (vakalar\u0131n %0,5’i) kad\u0131nlara invaziv prenatal test, riskin orta oldu\u011fu durumlarda (vakalar\u0131n %20’si) non-invaziv prenatal test (NIPT) yap\u0131lmas\u0131 gerekir ve risk d\u00fc\u015f\u00fck ise (vakalar\u0131n %80’i), hamile kad\u0131na olas\u0131l\u0131\u011f\u0131n minimum oldu\u011fu konusunda g\u00fcvence verilmelidir.<\/div>\n

Sonu\u00e7 olarak, ka\u00e7 tanesi amniyosentez yapacak?<\/strong><\/h4>\n

B\u00f6yle bir politika ile sonunda trizomilerin %98’i ke\u015ffedilir ve hamile kad\u0131nlar\u0131n yaln\u0131zca %0,8’i invaziv prenatal teste tabi tutulur; bu oran yaln\u0131zca ultrason tarama testi yap\u0131ld\u0131\u011f\u0131nda %2,6 ve yaln\u0131zca NIPT yap\u0131ld\u0131\u011f\u0131nda %1,4’t\u00fcr..<\/p>\n

\"181413-cfDNA_7\"<\/a><\/div><\/div>\n

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