27 Nisan 2010 Salı

Tüp Bebekte Çoğul Gebeliğin Riski!

Tüp bebek uygulamalarında çoğul gebeliklerin erken doğum ve buna bağlı sakatlık ve zeka geriliği riskini beraberinde getirdiği, ancak uzun yıllardır bebek isteyen anne-baba adaylarının bu riski görmezden geldiği bildirildi.

Türk Jinekoloji ve Obstetrik (hamilelik ve doğumla ilgili bilim dalı)Derneği Başkanı ve Gazi Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Anabilim Dalı Öğretim Üyesi Prof. Dr. Bülent Tıraş, tüp bebek uygulamasının, çocuk sahibi olamayan çiftlerin sıkça başvurduğu bir yöntem olduğuna dikkati çekti.
Tüp bebek uygulamasında, anne adayına Sağlık Bakanlığının belirlediği standart olan ortalama 3 embriyo transfer edildiğini anlatan Tıraş, "ancak, eğer hastanın yaşının ileri olması gibi nedenlerle gebe kalma ihtimali azsa, embriyo sayısı artırılabilir. Embriyo sayısı artırımı, söz konusu özel durumlarda yapılmalıdır.

Ancak, ihtiyaç olmadığı halde, yalnızca gebelik ihtimalini yükseltmek amacıyla embriyo sayısını artırmak, beraberinde önemli sorunları getirebilir" dedi. Embriyo sayısının artırılmasının, "çoğul gebelik" ihtimalini yükselttiğini söyleyen Tıraş, "Çoğul gebelik, iki ve fazla fetusun geliştiği gebeliktir. Tüp bebek yöntemiyle nakledilen embriyo sayısı ne kadar çok olursa, rahme düşecek embriyo sayısı da artacaktır. Yani ikiz, üçüz, dördüz, hatta daha fazla sayıda fetus aynı anda gelişmeye başlayacaktır" dedi.

ÇOĞUL GEBELİĞİN RİSKLERİ
Türk Neonatoloji (yeni doğan hastalıkları) Derneği Başkanı Prof. Dr. Murat Yurdakök de çoğul gebeliğin tüp bebek uygulamasında başarı olarak görülmemesi gerektiğini söyledi. Anne rahminin en fazla 2 bebek için uygun olduğunu, daha fazla sayının erken doğumlara, bebeklerde sakatlığa veya zeka geriliği gibi kalıcı sorunlara neden olabileceğini ifade eden Yurdakök, "tüp bebek uygulaması yapılan anne ve baba adaylarına, tüp bebek uygulama merkezlerinde bilgilendirme çok iyi şekilde yapılmalı, çoğul gebeliğin riskleri iyice anlatılmalı. Ancak, bazen anlatılsa dahi uzun yıllar bebek sevdası yaşayan anne-baba adayları, bu riski görmezden gelmekte ve tüp bebek uygulamasında normalin çok üzerinde sayıda embriyonun transferini istemekteler" dedi.
Çoğul gebeliğin annenin hayatını da tehlikeye attığını belirten Yurdakök, tüp bebek uygulamalarında Sağlık Bakanlığının belirlediği standartlara bağlı kalınması gerektiğini vurguladı.
Yıllık kontrollerimi ne sıklıkta yaptırmam gerekir?
Menopozun belirtileri nelerdir?

Öncesinde hangi testler yaptırılmalı? Muayeneler ne sıklıkta yapılmalı? Uzmanlar yanıtlıyor... Soru: Yıllık jinekolojik muayene kontrollerimi ne sıklıkta yaptırmam gerekir?

Kadın Hastalıkları ve Doğum Uzmanı :

Yılda bir kez smear testi ve jinekolojik muayene, kadınları jinekolojik kanserlerden koruyup, erken tanı sağlayabiliyor. Yapılan tetkikler kadının yaşına göre farklılık göstermektedir. Genç yaş grubundaki üreme çağındaki kadınların cinsel aktivitenin başlangıcından itibaren yılda bir jinekolojik muayene, vajinal smear tetkiki, meme muayenesi, ultrasonografik muayene ile rahim yumurtalık ve rahim içi zarı değerlendirilmesini mutlaka yaptırması gerekiyor.

40 yaş üzeri hastalarda ise bunlara ek olarak mammografi ve gerekirse meme ultrasonografisi, kan biyokimyası (kan lipidleri, açlık kan şekeri, karaciğer ve böbrek fonksiyon testleri, tiroid fonksiyon testleri), gaitada gizli kan tetkiki yılda bir kontrol ediliyor.Rutin sağlık taramalarında kadınlardan özgeçmişe ait detaylı sağlık bilgileri alınarak mevcut risk faktörleri belirleniyor. Takiben ultrasonografik değerlendirme eşliğinde jinekolojik muayene yapılıyor ve bu esnada vajinal smear alınıyor.Gerek üreme çağında ve gerekse menopoz sonrası dönemde kadınlarda en sık yapılan tarama testi vajinal smear tetkikidir. Vajinal smear testi rahim ağzı kanserlerinin erken tanı ve taramasında kullanılan bir testti.

Menopozun belirtileri nelerdir? Öncesinde hangi testleri yaptırmalıyım?

Kadın Hastalıkları ve Doğum Uzmanı :

Menopoz döneminde doğurganlık çağı bitmekte ve overler fonksiyon bakımından saf dışı olmakta, kadın için doğurganlığın ortadan kalktığı yeni bir çağ başlamaktadır. Genelde olayın ortaya çıkmasının nedeninin overin yaşlanması olduğu kabul edilmektedir. Sonuçta kadın östrojen metabolizmasında azalma görüldüğünden, bu sürede görülen belirtilere "östrojen yetersizliği sendromu" da denilmektedir.Genellikle bu devre 40 ile 60 yaş arasındadır. Menopoza girme yaşı toplumdan topluma değişiklik göstermektedir. Gelişmiş toplumlarda çeşitli çevresel etkilerin bu yaşı etkilediği kabul edilmektedir. Ülkemizde bu yaş 46,5-47 civarındadır. Kadınların yaşamını 1/4, 1/3'lük kısmı menopozda geçmektedir.

Ortalama yaşam süresi tüm dünyada uzamış olduğundan bu dönemde koruyucu hekimliğine çok iş düşmektedir.Kadınlarda 40 yaştan sonra her 5 yılda bir tam fiziki muayene, yıllık meme ve jinekolojik muayene, pap-smear testi, gerekirse cinsel yolla bulaşan hastalıkların taraması yapılmalıdır.40'lı yaşlarda bir TSH ölçümü yapılmalı ve 60 yaştan sonra 2 yılda bir tekrarlanmalıdır.50'li yaşlardan sonra gaitada gizli kan bakılmalıdır.

Yine 40'lı yaşlarda mammografik tetkike başlanması önerilmektedir.Menopoz tanısı ağırlıklı olarak klinik açıdan konulmaktadır. Menopoza yakın dönemde adet kanamalarının karakteri değişik şekillerde olabilir. Hastanın adeti tamamen kesilebilir. Adet kanamasının hem süresi hem de miktarı kademeli olarak azalabilir ve bu en sık rastlanan tiptir.Bazı kadınlarda kanama miktarı artar ve düzensiz olabilir. Bu durumda özellikle jinekoloğa başvurulmalıdır.

Hypertension in the African American Community If you are like most people, you or someone you know has high blood pressure. For a variety of reasons, the unfortunate truth is that the prevalence of hypertension in African Americans is among the highest in the world. This fact makes hypertension one of our primary targets in the campaign to improve health and wellness.
Poorly controlled hypertension can lead to a variety of serious health problems including strokes, heart disease and kidney failure. African Americans suffer from the complications of hypertension at alarmingly high rates.

Often, we do not receive treatment until the blood pressure has been elevated for many years and has already began to damage organs in the body. Compared to Whites, African Americans develop hypertension at an earlier age and are more prone to have substantially elevated pressures. Data reveal that compared to the general population, African Americans have: A 80% higher death rate associated with strokes due to hypertension. A 50% higher death rate associated with heart disease due to hypertension. A 320% higher death rate associated with end-stage kidney disease.

Quick Refresher: The Basics of Our Circulatory System Our circulatory system consists of several components that act in harmony to transport nutrients and oxygen to our tissues and remove waste products. Let’s quickly review the key components.Blood A fluid made up of blood cells and plasma that circulates throughout the body. Blood caries a variety of substances (oxygen and waste products) that are transported between various organs and tissues.Heart Muscular organ that pumps oxygen poor (deoxygenated) blood into the lungs and pumps the newly oxygenated blood out to the body.

Vessels Vessels are arteries and veins and can be thought of as the “tubing” which carries blood throughout our bodies. For the most part, arteries are the blood vessels that carry oxygen rich blood to our organs and tissues. Veins carry the oxygen poor blood back to the heart. Lungs Responsible for the oxygenation of our blood.What is Blood Pressure? Blood pressure refers to the pressure blood exerts against the walls of the main arteries in our bodies. The systolic pressure is the pressure in the vessels when the heart is pumping. The diastolic pressure is the pressure of the blood between heartbeats (when the heart is at rest). When you see or are told of a blood pressure of 120/80 or 120 over 80…the systolic pressure is120 and the diastolic pressure is 80.

What Defines Hypertension? Hypertension is defined as an average systolic blood pressure of 140 mm Hg (millimeters of mercury) or higher and/or an average diastolic blood pressure of 90 mm Hg or higher. It is important to point out that blood pressure readings can be different at varying times of the day and can be elevated with stress or anxiety. Therefore, the determination of a person being labeled as “hypertensive” is usually based on the average of three blood pressure readings taken on different days. The following chart is adapted form the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). Category Systolic (mm Hg) Diastolic (mm Hg) Optimal<120and<80normal<130and<85high>

Stage 3>=180Or>=110Hypertension and Diabetes Mellitus Controlling blood pressure is extremely important in diabetic patients with hypertension. Properly controlling blood pressure helps to prevent damage to the kidneys and can help to control the development of diabetic nephropathy (diabetes related kidney disease). The goal for diabetic patients with hypertension is to keep the blood pressure below 130/85 mm Hg. A combination of anti-hypertensive medications and lifestyle changes (especially weight loss) should be used to reach this blood pressure goal.

Hypertension Associated with Birth Control Pills Many women taking birth control pills experience a small increase in blood pressure, but the pressure usually remains in the normal range. Hypertension has been reported to be 2-3 times more common in women taking birth control pills and is most evident in obese and older women.

Women over 35 years of age who smoke are advised against taking birth control pills as they are at an increased risk of developing hypertension. Hypertension and Kidney Disease The early detection of kidney damage from hypertension is very important. Your doctor can order blood tests that can determine whether or not there is evidence of damage. Blood pressure should be controlled to levels of 130/85 mm Hg or lower. The goal here is to prevent advanced or “end-stage” kidney failure requiring the need for dialysis.

Evaluation and Diagnosis The initial screening for hypertension is fairly simple and straightforward.
All you need to do is have your blood pressure measured with a cuff that is placed around your arm and then inflated (technically it is called a sphygmomanometer). As a basic rule, if the average of three blood pressure readings (on different days) is over 140/90 mm Hg it can be concluded that you have hypertension. The exact cause of hypertension in most cases is not known. In the medical community this is referred to as “essential” hypertension. A combination of genetics, diet, and lifestyle certainly play a large role in the development of high blood pressure. It is very important to point out that if you develop hypertension at a young age or the hypertension develops suddenly, your doctor should carefully evaluate you for causes of hypertension that are potentially reversible.

You may need special studies that will evaluate the vessels that supply blood to your kidneys and for other potential disorders in your endocrine system. Treatment Lifestyle ChangesFor most individuals, the first step in treating hypertension is to make lifestyle changes. This means losing weight, increasing the amount of exercise you get, and changing your diet. Our accompanying article Controlling Hypertension Throughout Our Life Cycle discusses these lifestyle changes in more detail. In general, decreasing the sodium (salt) in your diet, eating more fruits and vegetables, and getting more aerobic exercise can help to lower your blood pressure. It will take some effort on your part! Anti-Hypertensive MedicationsIf the lifestyle changes mentioned above are unable to control your blood pressure, your doctor may prescribe medication(s).

There are a variety of different medications available and your doctor will prescribe the medication that is best for you. Some medications are better for people with diabetes, heart disease, kidney disease, etc. If you cannot tolerate a certain medication because of adverse side effects, there are other options. Many people are often opposed to “taking a pill every day.” Please, please, please remember that taking a pill every day can be a much better option than developing a stroke, heart attack, or needing to have kidney dialysis because your blood pressure ran out of control for too long. Empowerment Points Hypertension (high blood pressure) is often asymptomatic but over time it leads to a variety of health problems including heart disease, strokes, and kidney failure. The prevalence of hypertension in African Americans is among the highest in the world.

Have your blood pressure checked and if it is elevated discuss treatment options with your doctor. The only way that we can beat hypertension is to confront it head on—make lifestyle changes and take your medication if your doctor prescribes it! References:Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI)Autism a Public Health ProblemAutism is a serious public health problem which impacts many children. According to a recent report from the Centers for Disease Control, 1 out of every 150 American eight-year-olds has some form of autism. The previous estimate was one in 166 children. This suggests that 560,000 children in the US have autism. The reason for the high percentage of autism remains unclear. The CDC is now conducting a study to try to identify the environmental factors associated with autism. Research has shown no differences based on race, ethnicity, or socioeconomic status in either the prevalence or incidence of autism in children. Although, the condition does not seem to differ in percentage by culture or race; diagnosis and treatment disparities do exist.

Healthcare Disparities and AutismAfrican-American children frequently are confronted with late diagnoses or misdiagnosis, according to the National Early Intervention Longitudinal Study done under a grant from the US Department of Education. The study suggests this may be due to evidence that African-Americans are less likely than Whites to see the same pediatrician over an extended period of time. A pediatrician who sees a child regularly over time may recognize autism sooner than those exposed less frequently at office visits. The study encourages African American parents to ask many questions and be persistent in getting their health care provider to diagnose autism related concerns.In a study done by David Mandell and Dr. John Listerud entitled, Race Differences in the Age at Diagnosis Among Medicaid-Eligible Children with Autism, African-American children with autism are diagnosed nearly two years after children of all other ethnic groups and they received more misdiagnoses than Whites. They also found that minority families and families with lower incomes or limited education had more difficulty entering the early intervention system for autism.

Early intervention is critical for better outcomes.
Advocating for vigilant diagnosis, treatment and education about this condition among the African American community can help lessen the disparity. What is Autism?Autism is a brain disorder that is connected to a variety of developmental problems, in communication and social interaction. The first signs of autism usually appear before age 3. Although there is no cure for autism, it is a treatable lifelong condition. The key feature of autism is impaired social interaction.According to the Mayo Clinic, children with autism have problems in three crucial areas of development — social skills, language and behavior. The most severe form of autism is evident by a complete inability to communicate or interact with other people. Often it is the parent that notices their child has symptoms suggestive of autism. Amy Higgins-Boyd, a Behaviorist that specializes in autistic children states, “Typically, they describe their infant child as showing little interest in others and having difficulty with changes in routines or their environment.

A child with autism may appear to develop normally and then withdraw and become unresponsive to social contact. Often children with autism engage in repetitive movements such as rocking and twirling, or in self-abusive behavior such a head-banging.” Higgins-Boyd also states the importance of joint attention as an important indicator. Joint attention behaviors represent a critical area in typical development, emerging between the ages of 9 and 15 months. Joint attention skills have been found to be related to receptive and expressive language skills among typically-developing children. Joint attention is important for the development of other skills as children age, such as more expressive language and symbolic play.

The National Institute of Neurological Disorder and Stroke (NINDS) report that Autism (sometimes called “classical autism”) is the most common condition in a group of developmental disorders known as the autism spectrum disorders (ASDs). Other ASDs include Asperger syndrome, Rett syndrome, childhood disintegrative disorder, and pervasive developmental disorder.

What about Vaccines? Are they safe?Vaccinations given to children have been suggested by some Americans to cause the onset of autism. This has primarily been linked to the fact that the characteristics of autism coincide with the timing of vaccinations. The measles, mumps and rubella (MMR) vaccine in particular is most often singled out as the culprit. The Centers for Disease Control and Prevention, the Institute of Medicine and the American Academy of Pediatrics all contend that vaccines including the MMR vaccine do not cause autism.How is Autism Diagnosed?According to NINDS, when doctors diagnose autism they look for the following behaviors using a screening instrument to gather information about a child’s development and behavior:impaired ability to make friends with peersimpaired ability to initiate or sustain a conversation with othersabsence or impairment of imaginative and social playstereotyped, repetitive, or unusual use of languagerestricted patterns of interest that are abnormal in intensity or focuspreoccupation with certain objects or subjectsinflexible adherence to specific routines or ritualsUpon recognition of autistic behaviors treatment and early intervention can be conducted.

Autism is a complex disorder, so it requires a diverse team to diagnose and treat the condition. Often diagnoses and treatment includes a neurologist, psychiatrist, speech therapist, and other professionals .If your child exhibits behaviors characteristic of autism make certain you are relying on a multi-disciplinary team to diagnose and treat your child. What does the research about autism provide?Researchers believe that gene studies will help unlock the mystery of autism. In a study done by National Institutes of Health, the National Alliance of Autism Research, the Hussman Foundation and the Autism Genetic Resource Exchange analyzed 54 African American families and 557 Caucasian families in which a member had autism. Researchers studied the genes that regulate a brain chemical or neurotransmitter called GABA along chromosome 15. Chromosome 15 has been linked to autism.

According to the researchers, GABA slows down nerve cells once their message has been transmitted to the brain acting as an information filter that prevents the brain from becoming over-stimulated. If the GABA system fails, the brain can be flooded with sensory information that overpowers the brain's processing capabilities, leading to some of the characteristic behaviors of autism. The largest research for autism genes to date, funded by the National Institutes of Health (NIH), has implicated components of the brain's glutamate chemical messenger system and a previously overlooked site on chromosome 11. Based on 1,168 families with at least two affected members, it adds to evidence that tiny, rare variations in genes may heighten risk for ASDs.

Among the new clues is stronger evidence for an association between autism and sites of genes. Continued genetic discoveries in this area will unleash the autism mystery and hopefully provide more research for curing this disease.Empowerment Points Be persistent with your doctor if you suspect your child has autismThe key research institutions do not believe autism is caused by vaccinationsLearn as much as you can about autism and pass it along to others. Early intervention is critical.If your child exhibits autistic behaviors ask many questions and make sure a multi-disciplinary medical team is helping you identify the problem.

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