Ac\u0131badem Adana Hastanesi Kad\u0131n Hastal\u0131klar\u0131 ve Do\u011fum Uzman\u0131 Prof. Dr. S\u00fcleyman Cansun Demir, 1958 y\u0131l\u0131ndan bu yana b\u00f6brek nakli ge\u00e7irmi\u015f 5 bin civar\u0131nda kad\u0131n\u0131n hamile kald\u0131\u011f\u0131n\u0131, do\u011furganl\u0131\u011f\u0131n b\u00f6brek nakli olanlardan \u00e7ok kronik b\u00f6brek yetersizli\u011fi olan ve halen diyaliz g\u00f6ren hastalarda azald\u0131\u011f\u0131n\u0131 s\u00f6yledi.<\/p>\n
Prof. Dr. Demir, \u00f6zellikle kronik b\u00f6brek rahats\u0131zl\u0131klar\u0131nda do\u011furganl\u0131\u011f\u0131n azald\u0131\u011f\u0131n\u0131 belirtek, uzun s\u00fcreli diyalize girenlerin ancak y\u00fczde 1\u2019inin gebe kalabildi\u011finin b\u00f6brek nakli olanlarda ise gebelik oran\u0131n\u0131n artt\u0131\u011f\u0131n\u0131 ifade etti.<\/p>\n
Demir, \u00f6nceden b\u00f6brek hastal\u0131\u011f\u0131 olan kad\u0131nlar\u0131n gebe kalabilmesi ve gebeli\u011fin sorunsuz devam edebilmesi, gebelik \u00f6ncesindeki hastal\u0131\u011f\u0131n derecesine ve hipertansiyonun varl\u0131\u011f\u0131na ba\u011fl\u0131 oldu\u011funu vurgulayarak, \u201cKronik b\u00f6brek hastas\u0131 kad\u0131nlarda her 4 ki\u015fiden birinde gebelik s\u0131ras\u0131nda hipertansiyon, yar\u0131s\u0131nda ise protein\u00fcri (idrarda protein varl\u0131\u011f\u0131) g\u00f6r\u00fcl\u00fcyor. Kronik b\u00f6brek hastal\u0131\u011f\u0131 olan kad\u0131nlarda gebelik kayb\u0131, rahim i\u00e7i b\u00fcy\u00fcme gerili\u011fi ve erken do\u011fum riski y\u00fckseliyor. Bu riskler akut b\u00f6brek rahats\u0131zl\u0131\u011f\u0131, nefrotik sendrom veya sonradan ortaya \u00e7\u0131kan hipertansiyon durumlar\u0131nda da ge\u00e7erli olabilir\u201d diye konu\u015ftu.<\/p>\n
32. haftaya kadar mutlaka takibi yap\u0131lmal\u0131<\/p>\n
B\u00f6brek hastal\u0131\u011f\u0131 olan gebelerin 32. haftaya kadar on be\u015f g\u00fcnde bir, sonras\u0131nda ise her hafta takip edilmesi gerekti\u011fini kaydeden Demir, \u201c\u0130deal olarak bu takibin perinatoloji uzmanlar\u0131 ve nefrologlar taraf\u0131ndan yap\u0131lmas\u0131 \u00f6neriliyor. Takiplerle beraber ayl\u0131k b\u00f6brek fonksiyon testleri ve 24 saatlik idrarda protein kayb\u0131n\u0131n da kay\u0131t alt\u0131na al\u0131nmas\u0131 \u00f6nem ta\u015f\u0131yor. Hastada tansiyon y\u00fckselmesi var ise bu durumun ciddiyetle takip tedavisi \u015fart. B\u00f6brek hastal\u0131\u011f\u0131 veya tansiyonun \u015fiddetlenmesi durumunda, e\u011fer fetus ya\u015fayaca\u011f\u0131 olgunlu\u011fa eri\u015fmi\u015fse do\u011fumun ger\u00e7ekle\u015ftirilmesi g\u00fcndeme gelebiliyor. Diyalize giren gebe hastalarda hem hemodiyaliz hem de periton diyalizi yap\u0131labiliyor ama periton diyalizi yap\u0131lacak hastalarda rahmin b\u00fcy\u00fcm\u00fc\u015f oldu\u011funun g\u00f6z \u00f6n\u00fcnde bulundurulmas\u0131 \u015fart. Bu d\u00f6nemde hemodiyalizin s\u0131kl\u0131\u011f\u0131 art\u0131r\u0131larak diyaliz \u00f6ncesindeki serum \u00fcre d\u00fczeyinin 50mg\/dl alt\u0131nda tutulmas\u0131 veya heparin dozlar\u0131 ayarlanarak vajinal kanamadan ve tam tersine p\u0131ht\u0131la\u015fmadan ka\u00e7\u0131n\u0131lmas\u0131 gerekli olabiliyor. Diyaliz s\u0131ras\u0131nda asit baz de\u011fi\u015fiklikleri, elektrolit d\u00fczeyleri ve hem annenin hem de bebe\u011fin hacim de\u011fi\u015fikliklerinin de dikkate al\u0131nmas\u0131 gerekiyor. Ek olarak gebelikte kans\u0131zl\u0131k \u015fiddetlenip kalsiyum emilimi artt\u0131\u011f\u0131ndan ve diyaliz hastalar\u0131 kalsiyum y\u00fcksekli\u011fine meyilli oldu\u011fundan D vitamini dozlar\u0131n\u0131n azalt\u0131lmas\u0131 \u00f6neriliyor. Bu d\u00f6nemde dikkatle takip edilmesi gereken bir di\u011fer konu NST olarak bilinen elektronik fetal monit\u00f6rizasyon. Hemodiyaliz erken kas\u0131lmalara neden olabilece\u011finden NST\u2019nin gebeli\u011fin ortalar\u0131ndan itibaren yap\u0131lmas\u0131 ve erken do\u011fuma kar\u015f\u0131 gerekli \u00f6nlemlerin al\u0131nmas\u0131 gerekiyor\u201d \u015feklinde konu\u015ftu.<\/p>\n
Gebe b\u00f6brek nakli olmu\u015fsa<\/p>\n
B\u00f6brek naklinin \u00fczerinden 2 y\u0131ldan fazla zaman ge\u00e7mi\u015f olan ve b\u00f6brek fonksiyonlar\u0131 d\u00fczenli \u00e7al\u0131\u015fan hastalarda ba\u011f\u0131\u015f\u0131kl\u0131k bask\u0131lay\u0131c\u0131 ila\u00e7larla ba\u015far\u0131l\u0131 gebelik sonu\u00e7lar\u0131 elde edilebildi\u011finin alt\u0131n\u0131 \u00e7izen Demir, \u201cAncak b\u00f6brek nakli olmu\u015f hastalarda ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 bask\u0131lamak hipertansiyon, erken kas\u0131lmalar ve enfeksiyon gibi riskleri art\u0131rabiliyor. Bu t\u00fcr durumlarda hastalar\u0131nda yar\u0131s\u0131nda y\u00fcksek tansiyona ba\u011fl\u0131 erken do\u011fum g\u00fcndeme gelebiliyor\u201d dedi.<\/p>\n
B\u00f6brek hastas\u0131 kad\u0131nlar\u0131n gebelik durumunda \u00fc\u00e7 ana gurupta de\u011ferlendirildi\u011fini belirten Prof. Dr. S\u00fcleyman Cansun Demir, \u015funlar\u0131 kaydetti:<\/p>\n
\u201cHafif bozukluk ya\u015fayanlarda gebelik alttaki hastal\u0131\u011f\u0131 olumsuz etkilemiyor ve do\u011fum sonras\u0131 \u00f6l\u00fcm oranlar\u0131 y\u00fczde 5\u2019in alt\u0131nda kal\u0131yor. Ancak nefrit durumunda risk art\u0131yor. Orta d\u00fczeyde fonksiyon b\u00f6brek bozuklu\u011fu olanlarda hamileli\u011finin ilk 3 ay\u0131ndaki d\u00fc\u015f\u00fck riski y\u00fcksek olmakla birlikte y\u00fczde 90\u2019a varan ba\u015far\u0131l\u0131 sonu\u00e7lar elde ediliyor. \u0130leri derecede bozukluk olanlarda ise ba\u015far\u0131 oran\u0131 y\u00fczde 40\u2019\u0131n alt\u0131na d\u00fc\u015f\u00fcyor. Bu hastalarda hayati risk olu\u015fturacak d\u00fczeyde y\u00fcksek tansiyon ve do\u011fumdan sonra bile d\u00fczelmeyen b\u00f6brek fonksiyon bozuklu\u011fu olabilir.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"
KRON\u0130K B\u00d6BREK HASTALI\u011eNINI DO\u011eURGANLI\u011eI AZALTTI\u011eI BEL\u0130RT\u0130LD\u0130.<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[1],"tags":[9250,11304,18957,13970,5959],"class_list":["post-174146","post","type-post","status-publish","format-standard","hentry","category-genel","tag-azaltiyor","tag-bobrek","tag-dogurganligi","tag-hastaligi","tag-kronik"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/paKIfm-JiO","_links":{"self":[{"href":"http:\/\/www.tvturk.com\/index.php\/wp-json\/wp\/v2\/posts\/174146","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/www.tvturk.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/www.tvturk.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/www.tvturk.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/www.tvturk.com\/index.php\/wp-json\/wp\/v2\/comments?post=174146"}],"version-history":[{"count":0,"href":"http:\/\/www.tvturk.com\/index.php\/wp-json\/wp\/v2\/posts\/174146\/revisions"}],"wp:attachment":[{"href":"http:\/\/www.tvturk.com\/index.php\/wp-json\/wp\/v2\/media?parent=174146"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/www.tvturk.com\/index.php\/wp-json\/wp\/v2\/categories?post=174146"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/www.tvturk.com\/index.php\/wp-json\/wp\/v2\/tags?post=174146"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}