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HAMİLELİKTE EN RİSKLİ DURUM; DÜŞÜK TEHLİKESİ

Kadın Hastalıkları ve Doğum Uzmanı Op. Dr. Meral Sönmezer konu hakkında önemli bilgiler verdi.

Gebelik kadın için annelik duygularının başladığı ilk andır. Çoğunlukla kadın gebe olduğunu öğrenir öğrenmez annelik dürtüleri başlar ve onu bebeğini her şeyden koruma içgüdüsüyle davranmaya çalışır. Bedeninde kendi varlığıyla beslediği bir canlının olduğunu bilmek, büyük bir mutluluğun yanı sıra büyük de bir sorumluluk hissi getirir.  Gebe olduğunu öğrenen anne adayı için özellikle ilk 3 ay olmak üzere ilk 20 haftalık süreç oldukça önemlidir.
Anne adayının vücudunun gebeliğe hazır olması bu dönemde oldukça önemlidir. Özellikle planlı gebeliklerde anne adayı gebe kalmadan üç ay öncesinde prekonsepsiyonel tetkikler denen kan ve idrar testlerini yaptırmalı, detaylı bir jinekolojik muayeneden geçerek smear ve gerekiyorsa HPV testlerini yaptırmalıdır. Yine bu dönemde hem tetkik sonuçlarına göre saptanacak hastalıkların tedavisi, eksik vitaminlerin yerine konması ve folik asit takviyesinin başlanması gereklidir. Böylece gebeliğe en optimal şekilde hazırlanmak mümkün olur.

Düşük nedir?

Gebeliğin ilk 20 haftalık sürecinde oluşan gebelik kayıplarına düşük denilmektedir. İlk 3 aylık süreçte olan gebelik kayıplarına erken düşük, 3 ayı geçtikten sonra 20. haftaya kadar olan düşüklere gecikmiş denilmektedir. Henüz düşük gerçekleşmemişken ortaya çıkan düşükle sonuçlanma riski olan belirtiler de ‘’düşük tehditi’’ olarak adlandırılır.

Düşüğün nedenleri nelerdir?

Anne karnındaki bebekte bulunan yapısal bozukluklar düşük nedenlerindendir.Anne adayının sağlık durumu ( tiroid problemleri, kronik hastalıklar, sistemik enfeksiyonlar vb) gebeliğin gidişatını belirleyen unsurlardandır. Bu sebeple risk faktörü olan anne adayı gebe kalmayı planladıklarında mutlaka ilgili branşlara da muayene olmalıdırlar. Tedavi olması gereken bir durum varsa tedavi edilmeli, vücutta eksik olan vitamin ve mineraller varsa belirlenerek yerine konulmalıdır.Anne adayının daha önceden düşük yapmış olması da sonraki gebelikte düşük nedenlerindendir.Yaş, obezite, sigara, alkol ve madde kullanımı da düşük nedenlerinden sayılabilmektedir.Anne adayının immünolojik bir bozukluğu mevcut ise, vücudu dışarıdan gelen herhangi bir şeye karşı antikor oluşturuyorsa bu durum da düşük nedenlerindendir.Servikal yetmezlikte serviks gebelik kesesini tutamayacak kadar güçsüz  durumda ise düşük gerçekleşebilmektedir.Gebeliğin sağlıklı ilerlemesini sağlayan, östrojen, progesteron gibi gebelik hormonlarının vücutta yeterli salınamaması da düşük nedenleri arasındadır.Genetik bozukluklar yine düşük nedenleri arasında sık görülenlerdendir. Yirminci haftadan önce gerçekleşen düşüklerin %70 inin nedeni bebeğin kromozomal bir anomalisinin bulunmasındandır.Gebeliğin başlangıcından itibaren rahim bebeği yabancı bir hücre olarak kabul edip tanımaya çalışırken bir yandan da onu korur. Riskli gebelik olmadığı sürece normal şartlarda günlük hareketler gebeliğe zarar vermez. Ancak ciddi travmalar ve fiziksel şiddet durumları gebeliğin düşükle sonuçlanmasına neden olabilmektedir.Rahim içerisinde myom ve polip gibi yapıların olması rahim içi dokuya bası yaparak veya bebeğin yerleşeceği endometrial yatağı bozarak düşüğe neden olabilmektedirler.Rubella, sitomegalovirus, listeria gibi enfeksiyonlar da düşüğe neden olmaktadır.Gebelikten önce geçirilmiş olan rahim içi enfeksiyonlar veya sert cerrahi işlemler nedeniyle oluşan rahim içi yapışıklıklar da düşüğe neden olabilmektedir.Anne adayında bulunan pıhtılaşma problemleri nedeniyle de gebelik düşükle sonuçlanabilir.Gebelikte beslenme oldukça önemlidir. Gebelikte tüketilen bazı bitki çayları gebelik döneminde düşüğe neden olabilmektedir.

Düşük belirtileri nelerdir?

Gebelikte düşük belirtilerinden en önemlisi vajinal kanamadır. Gebelikte lekelenme ya da aktif kanama olursa mutlaka gebeliğinizi takip den hekiminizi bilgilendirmelisiniz. Bu durumun istisnası gebelik testinin yeni pozitifleştiği ve çoğunlukla beklenen bir sonraki adet tarihine denk gelen günlerde oluşan leke şeklindeki kanamalardır. Bunlar her zaman düşük belirtisi değildir. Yerleşme kanaması olarak adlandırılan bu kanamalar herhangi bir müdahale olmadan kendiliğinden geçebilir.Gebelikte adet dönemindekine benzer hafif bel ve sırt ağrıları görülebilir. Bu ağrılarınız çok şiddetli oluyorsa ve hareketinizi engelleyecek boyuta varıyorsa mutlaka doktorunuzu bilgilendirmeniz gerekir.Şiddetli ve geçmeyen karın ve kasık ağrısı da düşük belirtilerindendir. Mutlaka doktorunuza bilgilendirmelisiniz.Kanamalı akıntı ya da pıhtılaşmış doku gelmesi durumunda da düşük tehditinden bahsedilir ve doktora başvurma gerekliliği vardır.

Düşük tedavisi nasıl olmaktadır?

Düşük eylemi başlamışsa ne yazık ki bunu durdurmanın bir yolu yoktur. Düşük tehdidine yol açan neden belli ise (örneğin hormon yetmezliği, servikal yetmezlik gibi) ona yönelik tedavi ve tedbirler düşüğü önlemede faydalı olabilir. Yine yatak istirahati ve yeterli hidrasyon da özellikle rahime yapışma güçlüğü nedeniyle ortaya çıkan durumlarda faydalı olabilir. Her şeye rağmen düşük eylemi başlamışsa, riskleri önlemek, kanamayı azaltmak ve hastanın bu süreçten psikolojik olarak en az etkilenmesini sağlamak amacıyla kürtaj ile müdahale edilebilir.

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