{"id":3958,"date":"2026-08-28T17:16:45","date_gmt":"2026-08-28T14:16:45","guid":{"rendered":"https:\/\/www.sonerduzguner.com\/?p=3958"},"modified":"2026-08-28T17:16:45","modified_gmt":"2026-08-28T14:16:45","slug":"servikal-yetmezlik-serklaj-turleri","status":"publish","type":"post","link":"https:\/\/www.sonerduzguner.com\/bg\/servikal-yetmezlik-serklaj-turleri\/","title":{"rendered":"Servikal Yetmezlik Nedir? Servikal ve Abdominal Serklaj T\u00fcrleri"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><div      class=\"vc_row wpb_row section vc_row-fluid\" style=' padding-bottom:40px; text-align:left;'><div class=\"full_section_inner clearfix\"><div class=\"wpb_column vc_column_container vc_col-sm-12\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\">\n\t<div class=\"wpb_raw_code wpb_raw_html wpb_content_element\" >\n\t\t<div class=\"wpb_wrapper\">\n\t\t\t<p><strong>Servikal yetmezlik veya rahim a\u011fz\u0131 yetmezli\u011fi<\/strong>, rahim a\u011fz\u0131n\u0131n gebeli\u011fi ta\u015f\u0131yacak yap\u0131sal ve fonksiyonel deste\u011fi sa\u011flayamamas\u0131 sonucunda, belirgin a\u011fr\u0131 ya da d\u00fczenli do\u011fum sanc\u0131s\u0131 olmadan erken k\u0131salmas\u0131 ve a\u00e7\u0131lmas\u0131d\u0131r.<\/p>\n\n<p>Bu durum \u00f6zellikle gebeli\u011fin ikinci trimesterinde <strong>ge\u00e7 gebelik kayb\u0131na, su kesesinin erken a\u00e7\u0131lmas\u0131na veya erken do\u011fuma<\/strong> neden olabilir. Servikal yetmezlik her zaman belirti vermeyebilir. Riskli gebelerde transvajinal ultrasonla rahim a\u011fz\u0131 uzunlu\u011funun takip edilmesi, gerekli durumlarda vajinal progesteron veya servikal serklaj uygulanmas\u0131 gebeli\u011fin daha ileri haftalara ta\u015f\u0131nmas\u0131na yard\u0131mc\u0131 olabilir.<\/p>\n\n<h2><span class=\"ez-toc-section\" id=\"i\"><\/span>Rahim a\u011fz\u0131n\u0131n gebelikteki g\u00f6revi nedir?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n<p>Serviks, di\u011fer ad\u0131yla <strong>rahim a\u011fz\u0131<\/strong>, rahmin vajinaya a\u00e7\u0131lan alt b\u00f6l\u00fcm\u00fcd\u00fcr. Sa\u011fl\u0131kl\u0131 bir gebelikte kapal\u0131 ve yeterince uzun kalarak bebe\u011fin rahim i\u00e7inde geli\u015fmesine yard\u0131mc\u0131 olur.<\/p>\n\n<p>Do\u011fum yakla\u015ft\u0131\u011f\u0131nda rahim a\u011fz\u0131 yumu\u015famaya, k\u0131salmaya ve a\u00e7\u0131lmaya ba\u015flar. Servikal yetmezlikte ise bu de\u011fi\u015fiklikler do\u011fum zaman\u0131 gelmeden, \u00e7o\u011funlukla <strong>gebeli\u011fin ikinci trimesterinde<\/strong> ortaya \u00e7\u0131kar.<\/p>\n\n<p>Servikal yetmezlik yaln\u0131zca <em>\u201crahim a\u011fz\u0131n\u0131n zay\u0131f olmas\u0131\u201d<\/em> \u015feklinde de\u011ferlendirilmemelidir. Rahim a\u011fz\u0131n\u0131n anatomisi, servikal uzunluk, \u00f6nceki gebeliklerin seyri, enfeksiyon ve erken do\u011fumu ba\u015flatabilecek di\u011fer biyolojik s\u00fcre\u00e7ler birlikte rol oynayabilir.<\/p>\n\n<h2><span class=\"ez-toc-section\" id=\"i-2\"><\/span>Servikal yetmezlik belirtileri nelerdir?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n<p>Rahim a\u011fz\u0131 yetmezli\u011fi bazen hi\u00e7bir belirti vermeden ilerleyebilir. Baz\u0131 anne adaylar\u0131nda ise \u015fu belirtiler g\u00f6r\u00fclebilir:<\/p>\n\n<ul>\n<li>Pelvik b\u00f6lgede bas\u0131n\u00e7 veya a\u015fa\u011f\u0131 do\u011fru bask\u0131 hissi<\/li>\n<li>Bel a\u011fr\u0131s\u0131<\/li>\n<li>Hafif kar\u0131n ya da kas\u0131k kramplar\u0131<\/li>\n<li>Vajinal ak\u0131nt\u0131da art\u0131\u015f veya k\u0131vam de\u011fi\u015fikli\u011fi<\/li>\n<li>Hafif vajinal kanama veya lekelenme<\/li>\n<li>Vajinada dolgunluk hissi<\/li>\n<li>Su gelmesi<\/li>\n<\/ul>\n\n<p>Bu belirtilerin bulunmas\u0131 mutlaka servikal yetmezlik oldu\u011fu anlam\u0131na gelmez. Ancak daha \u00f6nce <strong>ikinci trimester gebelik kayb\u0131 veya erken do\u011fum<\/strong> ya\u015fam\u0131\u015f anne adaylar\u0131n\u0131n gecikmeden de\u011ferlendirilmesi \u00f6nemlidir.<\/p>\n\n<blockquote><p><strong>\u00d6nemli:<\/strong> \u015eiddetli ya da d\u00fczenli a\u011fr\u0131, vajinal kanama, su gelmesi, ate\u015f veya k\u00f6t\u00fc kokulu ak\u0131nt\u0131 varsa acil olarak sa\u011fl\u0131k kurulu\u015funa ba\u015fvurulmal\u0131d\u0131r.<\/p><\/blockquote>\n\n<h2><span class=\"ez-toc-section\" id=\"i-3\"><\/span>Servikal yetmezlik neden olur?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n<p>Servikal yetmezli\u011fin kesin nedeni her hastada belirlenemeyebilir. Riski art\u0131rabilecek ba\u015fl\u0131ca durumlar \u015funlard\u0131r:<\/p>\n\n<ul>\n<li>A\u011fr\u0131s\u0131z rahim a\u011fz\u0131 a\u00e7\u0131lmas\u0131yla ger\u00e7ekle\u015fmi\u015f ikinci trimester gebelik kayb\u0131<\/li>\n<li>\u00d6nceki kendili\u011finden erken do\u011fum \u00f6yk\u00fcs\u00fc<\/li>\n<li>\u00d6nceki gebelikte servikal serklaj uygulanm\u0131\u015f olmas\u0131<\/li>\n<li>Rahim a\u011fz\u0131na uygulanm\u0131\u015f konizasyon veya benzeri cerrahi i\u015flemler<\/li>\n<li>Rahim a\u011fz\u0131nda ge\u00e7irilmi\u015f travma<\/li>\n<li>Rahim veya rahim a\u011fz\u0131ndaki do\u011fumsal yap\u0131sal farkl\u0131l\u0131klar<\/li>\n<li>Rahim a\u011fz\u0131n\u0131n belirgin derecede k\u0131sa olmas\u0131<\/li>\n<li>Rahim a\u011fz\u0131n\u0131 etkileyen baz\u0131 cerrahi operasyonlar<\/li>\n<\/ul>\n\n<p>Bu risk fakt\u00f6rlerinden birinin bulunmas\u0131 mutlaka servikal yetmezlik geli\u015fece\u011fi anlam\u0131na gelmez. Tan\u0131 ve takip plan\u0131; <strong>gebelik \u00f6yk\u00fcs\u00fc, ultrason ve muayene bulgular\u0131<\/strong> birlikte de\u011ferlendirilerek haz\u0131rlan\u0131r.<\/p>\n\n<h2><span class=\"ez-toc-section\" id=\"i-4\"><\/span>Servikal yetmezlik gebelik s\u0131ras\u0131nda anla\u015f\u0131labilir mi?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n<p>Evet, servikal yetmezlik gebelik s\u0131ras\u0131nda anla\u015f\u0131labilir. Ancak baz\u0131 hastalarda ilk bulgu a\u011fr\u0131s\u0131z rahim a\u011fz\u0131 a\u00e7\u0131lmas\u0131, su gelmesi veya ikinci trimester gebelik kayb\u0131 olabilir.<\/p>\n\n<p>Tan\u0131da \u00fc\u00e7 temel de\u011ferlendirme kullan\u0131l\u0131r:<\/p>\n\n<h3>\u00d6nceki gebelik \u00f6yk\u00fcs\u00fc<\/h3>\n\n<p>\u00d6nceki gebeliklerde belirgin a\u011fr\u0131 ve kas\u0131lma olmadan rahim a\u011fz\u0131n\u0131n a\u00e7\u0131lmas\u0131, ikinci trimester kayb\u0131, su kesesinin erken a\u00e7\u0131lmas\u0131 veya \u00e7ok erken do\u011fum ya\u015fanmas\u0131 servikal yetmezli\u011fi d\u00fc\u015f\u00fcnd\u00fcrebilir.<\/p>\n\n<h3>Transvajinal ultrason<\/h3>\n\n<p>Servikal uzunlu\u011fun de\u011ferlendirilmesinde en g\u00fcvenilir y\u00f6ntem <strong>transvajinal ultrasondur<\/strong>. Riskli hastalarda serviks uzunlu\u011fu \u00e7o\u011funlukla gebeli\u011fin <strong>16\u201324. haftalar\u0131 aras\u0131nda<\/strong> seri olarak \u00f6l\u00e7\u00fcl\u00fcr.<\/p>\n\n<p>Ultrason s\u0131ras\u0131nda yaln\u0131zca rahim a\u011fz\u0131n\u0131n uzunlu\u011fu de\u011fil, i\u00e7 k\u0131sm\u0131nda a\u00e7\u0131lma veya <em>\u201cfunneling\u201d<\/em> bulunup bulunmad\u0131\u011f\u0131 da de\u011ferlendirilir.<\/p>\n\n<h3>Fizik muayene<\/h3>\n\n<p>Baz\u0131 hastalarda spekulum veya vajinal muayene s\u0131ras\u0131nda rahim a\u011fz\u0131n\u0131n a\u011fr\u0131s\u0131z bi\u00e7imde a\u00e7\u0131ld\u0131\u011f\u0131 ve su kesesinin servikal kanala do\u011fru ilerledi\u011fi g\u00f6r\u00fclebilir.<\/p>\n\n<p>B\u00f6yle bir durumda enfeksiyon, do\u011fum eylemi, kanama ve su kesesinin durumu de\u011ferlendirilerek <strong>acil serklaj<\/strong> g\u00fcndeme gelebilir.<\/p>\n\n<h2><span class=\"ez-toc-section\" id=\"i-5\"><\/span>Servikal uzunluk ka\u00e7 milimetre olmal\u0131d\u0131r?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n<p>Servikal uzunluk gebelik haftas\u0131na, hastan\u0131n \u00f6yk\u00fcs\u00fcne ve gebeli\u011fin tekil veya \u00e7o\u011ful olmas\u0131na g\u00f6re de\u011ferlendirilir. Tedaviye y\u00f6n verecek \u00f6l\u00e7\u00fcmlerin standart y\u00f6ntemle ve transvajinal ultrason kullan\u0131larak yap\u0131lmas\u0131 gerekir.<\/p>\n\n<p>Tekil gebeli\u011fi bulunan ve \u00f6nceki kendili\u011finden erken do\u011fum \u00f6yk\u00fcs\u00fc olmayan bir hastada, gebeli\u011fin orta d\u00f6neminde servikal uzunlu\u011fun <strong>25 mm veya alt\u0131nda olmas\u0131 k\u0131sa serviks<\/strong> olarak kabul edilir.<\/p>\n\n<p>Ancak <strong>25 mm s\u0131n\u0131r\u0131, her hastaya otomatik olarak serklaj yap\u0131laca\u011f\u0131 anlam\u0131na gelmez.<\/strong><\/p>\n\n<h2><span class=\"ez-toc-section\" id=\"i-6\"><\/span>Servikal uzunluk ka\u00e7 milimetrenin alt\u0131ndaysa serklaj gerekir?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n<p>Serklaj karar\u0131 yaln\u0131zca rahim a\u011fz\u0131n\u0131n ka\u00e7 milimetre oldu\u011funa bak\u0131larak verilmez. Hastan\u0131n \u00f6nceki gebelik \u00f6yk\u00fcs\u00fc, mevcut gebelik haftas\u0131, rahim a\u011fz\u0131nda a\u00e7\u0131lma olup olmad\u0131\u011f\u0131 ve enfeksiyon bulgular\u0131 birlikte de\u011ferlendirilir.<\/p>\n\n<h3>\u00d6nceden erken do\u011fum veya servikal yetmezlik \u00f6yk\u00fcs\u00fc yoksa<\/h3>\n\n<p>Tekil gebelikte ve 24. haftadan \u00f6nce:<\/p>\n\n<ul>\n<li><strong>Serviks 21\u201325 mm aras\u0131ndaysa:<\/strong> Vajinal progesteron hasta ile birlikte karar verilerek d\u00fc\u015f\u00fcn\u00fclebilir.<\/li>\n<li><strong>Serviks 20 mm veya alt\u0131ndaysa:<\/strong> Vajinal progesteron \u00f6nerilir.<\/li>\n<li><strong>Serviks 10\u201325 mm aras\u0131ndaysa ve a\u00e7\u0131lma yoksa:<\/strong> Rutin serklaj \u00f6nerilmez.<\/li>\n<li><strong>Serviks 10 mm\u2019nin alt\u0131na kadar ilerleyici bi\u00e7imde k\u0131salm\u0131\u015fsa:<\/strong> \u00d6zellikle progesteron kullan\u0131lmas\u0131na ra\u011fmen k\u0131salma devam ediyorsa serklaj bireysel olarak de\u011ferlendirilebilir. Bu durumda bile serklaj otomatik bir zorunluluk de\u011fildir.<\/li>\n<li><strong>Fizik muayenede rahim a\u011fz\u0131 a\u00e7\u0131lm\u0131\u015fsa:<\/strong> Servikal uzunluktan ba\u011f\u0131ms\u0131z olarak acil serklaj de\u011ferlendirilebilir.<\/li>\n<\/ul>\n\n<p>SMFM, \u00f6nceki erken do\u011fum \u00f6yk\u00fcs\u00fc ve servikal a\u00e7\u0131lma bulunmayan hastalarda 10\u201325 mm aras\u0131ndaki k\u0131sa serviks i\u00e7in rutin serklaj \u00f6nermez. Serviksin 20 mm veya alt\u0131nda oldu\u011fu hastalarda \u00f6ncelikli yakla\u015f\u0131m vajinal progesterondur. <a href=\"https:\/\/publications.smfm.org\/publications\/560-society-for-maternal-fetal-medicine-consult-series-70\/\" target=\"_blank\" rel=\"noopener noreferrer\">SMFM k\u0131sa serviks k\u0131lavuzu<\/a><\/p>\n\n<p>ISUOG ise progesterona ra\u011fmen serviksin ilerleyici bi\u00e7imde 10 mm\u2019nin alt\u0131na k\u0131sald\u0131\u011f\u0131 se\u00e7ilmi\u015f hastalarda serklaj\u0131n d\u00fc\u015f\u00fcn\u00fclebilece\u011fini belirtmektedir. <a href=\"https:\/\/isuog.org\/static\/e45c9342-359c-4c5b-86fb71d52562303b\/ultrasound-in-preterm-birth.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">ISUOG erken do\u011fum ve serviks k\u0131lavuzu<\/a><\/p>\n\n<h3>\u00d6nceki erken do\u011fum veya ikinci trimester kayb\u0131 varsa<\/h3>\n\n<p>Tekil gebelikte daha \u00f6nce kendili\u011finden erken do\u011fum veya servikal yetmezlikle uyumlu ikinci trimester kayb\u0131 bulunuyorsa ve servikal uzunluk 24. haftadan \u00f6nce <strong>25 mm veya alt\u0131nda<\/strong> \u00f6l\u00e7\u00fcl\u00fcrse ultrasona dayal\u0131 serklaj d\u00fc\u015f\u00fcn\u00fclebilir.<\/p>\n\n<h3>Serviks \u00f6l\u00e7\u00fcm\u00fcne g\u00f6re genel yakla\u015f\u0131m<\/h3>\n\n<table style=\"width:100%; border-collapse:collapse; margin:20px 0;\">\n<thead>\n<tr>\n<th style=\"border:1px solid #ddd; padding:10px; text-align:left; background:#f5f7f7;\">Klinik durum<\/th>\n<th style=\"border:1px solid #ddd; padding:10px; text-align:left; background:#f5f7f7;\">Genel yakla\u015f\u0131m<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td style=\"border:1px solid #ddd; padding:10px;\">\u00d6yk\u00fc yok, tekil gebelik, serviks 21\u201325 mm<\/td>\n<td style=\"border:1px solid #ddd; padding:10px;\">Vajinal progesteron d\u00fc\u015f\u00fcn\u00fclebilir<\/td>\n<\/tr>\n<tr>\n<td style=\"border:1px solid #ddd; padding:10px;\">\u00d6yk\u00fc yok, tekil gebelik, serviks \u226420 mm<\/td>\n<td style=\"border:1px solid #ddd; padding:10px;\"><strong>Vajinal progesteron \u00f6nerilir<\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"border:1px solid #ddd; padding:10px;\">\u00d6yk\u00fc yok, serviks 10\u201325 mm, a\u00e7\u0131lma yok<\/td>\n<td style=\"border:1px solid #ddd; padding:10px;\">Rutin serklaj \u00f6nerilmez<\/td>\n<\/tr>\n<tr>\n<td style=\"border:1px solid #ddd; padding:10px;\">Progesterona ra\u011fmen serviks &lt;10 mm<\/td>\n<td style=\"border:1px solid #ddd; padding:10px;\">Serklaj bireysel olarak de\u011ferlendirilebilir<\/td>\n<\/tr>\n<tr>\n<td style=\"border:1px solid #ddd; padding:10px;\">Uygun erken do\u011fum\/kay\u0131p \u00f6yk\u00fcs\u00fc ve serviks \u226425 mm<\/td>\n<td style=\"border:1px solid #ddd; padding:10px;\"><strong>Serklaj d\u00fc\u015f\u00fcn\u00fclebilir<\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"border:1px solid #ddd; padding:10px;\">Muayenede a\u011fr\u0131s\u0131z servikal a\u00e7\u0131lma<\/td>\n<td style=\"border:1px solid #ddd; padding:10px;\">Enfeksiyon ve do\u011fum d\u0131\u015fland\u0131ktan sonra <strong>acil serklaj d\u00fc\u015f\u00fcn\u00fclebilir<\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n<h2><span class=\"ez-toc-section\" id=\"i-7\"><\/span>Servikal yetmezlik \u00f6nlenebilir mi?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n<p>Servikal yetmezli\u011fin b\u00fct\u00fcn vakalar\u0131n\u0131 \u00f6nlemek m\u00fcmk\u00fcn de\u011fildir. Ancak riskli hastalar\u0131n gebelikten \u00f6nce veya erken gebelik d\u00f6neminde belirlenmesiyle ge\u00e7 gebelik kayb\u0131 ve erken do\u011fum riski azalt\u0131labilir.<\/p>\n\n<p>Koruyucu yakla\u015f\u0131m \u015funlar\u0131 i\u00e7erebilir:<\/p>\n\n<ul>\n<li>\u00d6nceki gebelik kay\u0131plar\u0131n\u0131n ayr\u0131nt\u0131l\u0131 de\u011ferlendirilmesi<\/li>\n<li>Gebelik \u00f6ncesinde kad\u0131n hastal\u0131klar\u0131 ve do\u011fum muayenesi<\/li>\n<li>Riskli hastalarda 16\u201324. haftalar aras\u0131nda transvajinal serviks takibi<\/li>\n<li>Uygun hastalarda vajinal progesteron kullan\u0131lmas\u0131<\/li>\n<li>\u00d6yk\u00fc, ultrason veya muayene bulgular\u0131na g\u00f6re serklaj uygulanmas\u0131<\/li>\n<li>T\u00fcp bebek tedavisinde \u00e7o\u011ful gebelikten ka\u00e7\u0131n\u0131lmas\u0131<\/li>\n<li>Enfeksiyon belirtilerinin erken de\u011ferlendirilmesi<\/li>\n<\/ul>\n\n<p>Servikal yetmezli\u011fi \u00f6nlemek amac\u0131yla <strong>rutin ve uzun s\u00fcreli yatak istirahati \u00f6nerilmez.<\/strong> Hareketsiz kalmak p\u0131ht\u0131 olu\u015fumu, kas kayb\u0131 ve kemik zay\u0131flamas\u0131 gibi ek riskler do\u011furabilir.<\/p>\n\n<h2><span class=\"ez-toc-section\" id=\"i-8\"><\/span>T\u00fcp bebek tedavisinde \u00e7ift embriyo transferi uygun mudur?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n<p>Servikal yetmezlik, ikinci trimester gebelik kayb\u0131 veya \u00e7ok erken do\u011fum \u00f6yk\u00fcs\u00fc bulunan hastalarda <strong>\u00e7o\u011ful gebelikten ka\u00e7\u0131n\u0131lmas\u0131 \u00f6nemlidir.<\/strong><\/p>\n\n<p>\u0130kiz gebelik rahmin daha fazla gerilmesine ve erken do\u011fum riskinin artmas\u0131na neden olabilir. \u0130kiz gebelikte sonradan serklaj uygulanmas\u0131 da bu riski tamamen ortadan kald\u0131rmaz.<\/p>\n\n<p>Bu nedenle servikal yetmezli\u011fi veya ciddi erken do\u011fum \u00f6yk\u00fcs\u00fc bulunan t\u00fcp bebek hastalar\u0131nda <strong>elektif tek embriyo transferi g\u00fc\u00e7l\u00fc bi\u00e7imde tercih edilmelidir.<\/strong><\/p>\n\n<p>\u00c7ift embriyo transferini her hasta i\u00e7in <em>\u201cmutlak kontrendikasyon\u201d<\/em> \u015feklinde tan\u0131mlamak do\u011fru de\u011fildir. Bununla birlikte, \u00e7o\u011ful gebeli\u011fin ciddi sa\u011fl\u0131k risklerini art\u0131rabilece\u011fi hastalarda birden fazla embriyo transfer edilmemesi ve tek embriyo transferinin \u00f6ncelikli olarak de\u011ferlendirilmesi daha g\u00fcvenli bir yakla\u015f\u0131md\u0131r.<\/p>\n\n<p>ASRM, \u00e7o\u011ful gebeli\u011fin \u00f6nemli sa\u011fl\u0131k riski do\u011furabilece\u011fi hastalarda birden fazla embriyo transfer edilmemesini \u00f6nermektedir. Tek embriyo transferi, yard\u0131mc\u0131 \u00fcreme tedavilerinde \u00e7o\u011ful gebeli\u011fi azaltman\u0131n en do\u011frudan yoludur. <a href=\"https:\/\/prod.asrm.org\/practice-guidance\/practice-committee-documents\/guidance-on-the-limits-to-the-number-of-embryos-to-transfer-a---committee-opinion-2021\/\" target=\"_blank\" rel=\"noopener noreferrer\">ASRM embriyo transferi \u00f6nerileri<\/a><\/p>\n\n<h2><span class=\"ez-toc-section\" id=\"i-9\"><\/span>\u0130kiz gebelikte serklaj yap\u0131l\u0131r m\u0131?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n<p>\u0130kiz gebeliklerde yaln\u0131zca k\u0131sa serviks saptanmas\u0131na dayanarak <strong>rutin serklaj yap\u0131lmas\u0131 \u00f6nerilmez.<\/strong> \u0130kiz gebelikte serviks k\u0131salmas\u0131n\u0131n nedenleri ve tedaviye verilen yan\u0131t tekil gebeliklerden farkl\u0131 olabilir.<\/p>\n\n<p>SMFM, ikiz gebeliklerde servikal k\u0131salma nedeniyle serklaj, progesteron veya servikal peserin rutin kullan\u0131m\u0131n\u0131 klinik ara\u015ft\u0131rmalar d\u0131\u015f\u0131nda \u00f6nermemektedir. Bununla birlikte, fizik muayenede belirgin servikal a\u00e7\u0131lma saptanan \u00f6zel durumlarda karar perinatoloji de\u011ferlendirmesiyle bireyselle\u015ftirilebilir.<\/p>\n\n<p>Bu nedenle t\u00fcp bebek tedavisinde ikiz gebeli\u011fi sonradan serklajla g\u00fcvence alt\u0131na almaya \u00e7al\u0131\u015fmak yerine, m\u00fcmk\u00fcn oldu\u011funca <strong>tekil gebelik hedeflenmelidir.<\/strong><\/p>\n\n<h2><span class=\"ez-toc-section\" id=\"i-10\"><\/span>Servikal serklaj nedir?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n<p><strong>Servikal serklaj<\/strong>, rahim a\u011fz\u0131n\u0131n erken a\u00e7\u0131lmas\u0131n\u0131 \u00f6nlemek veya geciktirmek amac\u0131yla serviksin \u00e7evresine g\u00fc\u00e7l\u00fc bir diki\u015f yerle\u015ftirilmesidir. Halk aras\u0131nda <em>\u201crahim a\u011fz\u0131na diki\u015f at\u0131lmas\u0131\u201d<\/em> \u015feklinde de bilinir.<\/p>\n\n<p>Serklaj\u0131n amac\u0131 b\u00fct\u00fcn erken do\u011fumlar\u0131 kesin olarak engellemek de\u011fildir. Do\u011fru hastada ve uygun zamanda uyguland\u0131\u011f\u0131nda ge\u00e7 gebelik kayb\u0131 ve erken do\u011fum riskini azaltarak gebeli\u011fin daha ileri haftalara ula\u015fmas\u0131na yard\u0131mc\u0131 olabilir.<\/p>\n\n<h2><span class=\"ez-toc-section\" id=\"i-11\"><\/span>Uygulanma nedenine g\u00f6re serklaj t\u00fcrleri<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n<p>Serklaj, uygulanma nedenine g\u00f6re \u00fc\u00e7 ana gruba ayr\u0131l\u0131r.<\/p>\n\n<h3>\u00d6yk\u00fcye dayal\u0131 serklaj<\/h3>\n\n<p>\u00d6yk\u00fcye dayal\u0131 serklaj, hastan\u0131n \u00f6nceki gebeliklerinde ya\u015fanan olaylara g\u00f6re planlan\u0131r.<\/p>\n\n<p>\u00d6zellikle \u015fu durumlarda d\u00fc\u015f\u00fcn\u00fclebilir:<\/p>\n\n<ul>\n<li>A\u011fr\u0131s\u0131z rahim a\u011fz\u0131 a\u00e7\u0131lmas\u0131yla ger\u00e7ekle\u015fmi\u015f ikinci trimester kayb\u0131<\/li>\n<li>Tekrarlayan ge\u00e7 gebelik kay\u0131plar\u0131<\/li>\n<li>\u00d6nceki gebelikte servikal yetmezlik nedeniyle serklaj uygulanm\u0131\u015f olmas\u0131<\/li>\n<\/ul>\n\n<p>\u0130\u015flem \u00e7o\u011funlukla gebeli\u011fin <strong>12\u201314. haftalar\u0131<\/strong> civar\u0131nda planlan\u0131r. Kesin zamanlama hastan\u0131n ge\u00e7mi\u015fine ve mevcut gebeli\u011fin durumuna g\u00f6re belirlenir.<\/p>\n\n<h3>Ultrason bulgular\u0131na dayal\u0131 serklaj<\/h3>\n\n<p>Seri transvajinal ultrason takiplerinde rahim a\u011fz\u0131n\u0131n belirgin \u015fekilde k\u0131sald\u0131\u011f\u0131n\u0131n g\u00f6r\u00fclmesi \u00fczerine uygulanan serklajd\u0131r.<\/p>\n\n<p>\u00d6zellikle daha \u00f6nce kendili\u011finden erken do\u011fum veya ikinci trimester kayb\u0131 bulunan ve mevcut tekil gebeli\u011finde 24. haftadan \u00f6nce serviks uzunlu\u011fu <strong>25 mm veya alt\u0131nda<\/strong> \u00f6l\u00e7\u00fclen hastalarda de\u011ferlendirilebilir.<\/p>\n\n<p>Ultrasonda k\u0131sa serviks g\u00f6r\u00fclmesi her hastaya otomatik olarak serklaj uygulanaca\u011f\u0131 anlam\u0131na gelmez.<\/p>\n\n<h3>Fizik muayeneye dayal\u0131 acil serklaj<\/h3>\n\n<p>Gebeli\u011fin ikinci trimesterinde rahim a\u011fz\u0131n\u0131n a\u011fr\u0131s\u0131z bi\u00e7imde a\u00e7\u0131ld\u0131\u011f\u0131n\u0131n g\u00f6r\u00fclmesi \u00fczerine de\u011ferlendirilen serklajd\u0131r. <em>\u201cAcil serklaj\u201d<\/em> veya <em>\u201ckurtar\u0131c\u0131 serklaj\u201d<\/em> olarak da adland\u0131r\u0131l\u0131r.<\/p>\n\n<p>Baz\u0131 hastalarda su kesesi rahim a\u011fz\u0131na veya vajinaya do\u011fru ilerlemi\u015f olabilir. Acil serklaj, planl\u0131 serklaja g\u00f6re daha y\u00fcksek enfeksiyon ve su kesesinin a\u00e7\u0131lmas\u0131 riski ta\u015f\u0131r.<\/p>\n\n<p>\u0130\u015flem \u00f6ncesinde <strong>aktif enfeksiyon, kanama, rahim kas\u0131lmalar\u0131 ve su kesesinin durumu<\/strong> dikkatle de\u011ferlendirilir.<\/p>\n\n<h2><span class=\"ez-toc-section\" id=\"i-12\"><\/span>Uygulama yoluna g\u00f6re serklaj t\u00fcrleri<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n<p>Serklaj, diki\u015fin yerle\u015ftirildi\u011fi yola g\u00f6re iki temel gruba ayr\u0131l\u0131r:<\/p>\n\n<ul>\n<li><strong>Transvajinal serklaj<\/strong><\/li>\n<li><strong>Transabdominal serklaj<\/strong><\/li>\n<\/ul>\n\n<h2><span class=\"ez-toc-section\" id=\"i-13\"><\/span>Transvajinal serklaj nedir?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n<p>Transvajinal serklaj, diki\u015fin vajinal yoldan rahim a\u011fz\u0131n\u0131n \u00e7evresine yerle\u015ftirilmesidir. <strong>\u00c7o\u011fu hasta i\u00e7in ilk tercih edilen y\u00f6ntemdir.<\/strong><\/p>\n\n<p>Cerrahi y\u00fck\u00fcn\u00fcn abdominal serklaja g\u00f6re daha d\u00fc\u015f\u00fck olmas\u0131, diki\u015fin kolay \u00e7\u0131kar\u0131labilmesi ve uygun hastalarda vajinal do\u011fuma izin vermesi ba\u015fl\u0131ca avantajlar\u0131d\u0131r.<\/p>\n\n<p>Transvajinal serklajda en s\u0131k kullan\u0131lan y\u00f6ntemler <strong>McDonald ve Shirodkar teknikleridir.<\/strong><\/p>\n\n<h3>McDonald serklaj\u0131<\/h3>\n\n<p>McDonald serklaj\u0131nda rahim a\u011fz\u0131n\u0131n \u00e7evresine kese a\u011fz\u0131na benzer \u015fekilde diki\u015f yerle\u015ftirilir. Teknik olarak daha basit olmas\u0131 ve diki\u015fin kolay \u00e7\u0131kar\u0131labilmesi nedeniyle en s\u0131k kullan\u0131lan y\u00f6ntemlerden biridir.<\/p>\n\n<h3>Shirodkar serklaj\u0131<\/h3>\n\n<p>Shirodkar serklaj\u0131nda diki\u015f rahim a\u011fz\u0131n\u0131n daha \u00fcst seviyesine yerle\u015ftirilir. Baz\u0131 durumlarda mesanenin rahim a\u011fz\u0131ndan ayr\u0131lmas\u0131 gerekebilir. Bu nedenle McDonald y\u00f6ntemine g\u00f6re teknik olarak daha kapsaml\u0131 olabilir.<\/p>\n\n<p>Hangi tekni\u011fin kullan\u0131laca\u011f\u0131 rahim a\u011fz\u0131n\u0131n anatomisine, \u00f6nceki ameliyatlara ve hekimin de\u011ferlendirmesine g\u00f6re belirlenir. <strong>Bir y\u00f6ntemin b\u00fct\u00fcn hastalarda di\u011ferinden \u00fcst\u00fcn oldu\u011fu s\u00f6ylenemez.<\/strong><\/p>\n\n<h2><span class=\"ez-toc-section\" id=\"i-14\"><\/span>Abdominal serklaj nedir?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n<p><strong>Abdominal serklaj<\/strong>, diki\u015fin a\u00e7\u0131k cerrahi veya laparoskopik y\u00f6ntemle kar\u0131ndan girilerek rahim a\u011fz\u0131n\u0131n \u00fcst k\u0131sm\u0131na yerle\u015ftirilmesidir.<\/p>\n\n<p>Cerrahi y\u00fck\u00fc transvajinal serklajdan daha fazla oldu\u011fu i\u00e7in rutin olarak ilk se\u00e7enek de\u011fildir.<\/p>\n\n<h3>Abdominal serklaj kimlere uygulanabilir?<\/h3>\n\n<p>Abdominal serklaj \u015fu durumlarda de\u011ferlendirilebilir:<\/p>\n\n<ul>\n<li>Uygun \u015fekilde yap\u0131lm\u0131\u015f vajinal serklaja ra\u011fmen \u00e7ok erken do\u011fum veya gebelik kayb\u0131 ya\u015fanmas\u0131<\/li>\n<li>Rahim a\u011fz\u0131n\u0131n \u00f6nceki ameliyatlar nedeniyle belirgin derecede k\u0131salm\u0131\u015f olmas\u0131<\/li>\n<li>Vajinal yoldan serklaj yerle\u015ftirmenin anatomik olarak m\u00fcmk\u00fcn olmamas\u0131<\/li>\n<li>Rahim a\u011fz\u0131n\u0131 etkileyen trakelektomi gibi bir ameliyat ge\u00e7irilmesi<\/li>\n<li>\u00d6nceki vajinal serklaj\u0131n ba\u015far\u0131s\u0131z olmas\u0131<\/li>\n<\/ul>\n\n<p>SMFM, daha \u00f6nce vajinal serklaj uygulanmas\u0131na ra\u011fmen sonraki tekil gebeli\u011fi <strong>28. haftadan \u00f6nce kendili\u011finden do\u011fumla sonu\u00e7lanan<\/strong> hastalara transabdominal serklaj se\u00e7ene\u011finin sunulmas\u0131n\u0131 \u00f6nermektedir. <a href=\"https:\/\/publications.smfm.org\/publications\/471-society-for-maternal-fetal-medicine-consult-series-65\/\" target=\"_blank\" rel=\"noopener noreferrer\">SMFM transabdominal serklaj k\u0131lavuzu<\/a><\/p>\n\n<h3>Abdominal serklaj ne zaman yap\u0131l\u0131r?<\/h3>\n\n<p>Abdominal serklaj tercihen <strong>gebelikten \u00f6nce veya gebeli\u011fin ilk trimesterinde<\/strong> uygulan\u0131r. Hastan\u0131n durumuna g\u00f6re laparoskopik ya da a\u00e7\u0131k cerrahi tercih edilebilir.<\/p>\n\n<p>Diki\u015f \u00e7o\u011funlukla \u00e7\u0131kar\u0131lmaz ve sonraki gebelikler i\u00e7in yerinde b\u0131rak\u0131labilir. Ancak diki\u015f do\u011fum kanal\u0131n\u0131n \u00fcst b\u00f6l\u00fcm\u00fcnde bulundu\u011fundan <strong>do\u011fumun sezaryenle ger\u00e7ekle\u015ftirilmesi gerekir.<\/strong><\/p>\n\n<h2><span class=\"ez-toc-section\" id=\"i-15\"><\/span>Vajinal serklaj m\u0131, abdominal serklaj m\u0131?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n<p>\u00c7o\u011fu hasta i\u00e7in ilk se\u00e7enek <strong>transvajinal serklajd\u0131r.<\/strong> Abdominal serklaj\u0131n herkese daha iyi veya daha g\u00fc\u00e7l\u00fc bir y\u00f6ntem oldu\u011fu d\u00fc\u015f\u00fcn\u00fclmemelidir.<\/p>\n\n<table style=\"width:100%; border-collapse:collapse; margin:20px 0;\">\n<thead>\n<tr>\n<th style=\"border:1px solid #ddd; padding:10px; text-align:left; background:#f5f7f7;\">\u00d6zellik<\/th>\n<th style=\"border:1px solid #ddd; padding:10px; text-align:left; background:#f5f7f7;\">Transvajinal serklaj<\/th>\n<th style=\"border:1px solid #ddd; padding:10px; text-align:left; background:#f5f7f7;\">Transabdominal serklaj<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td style=\"border:1px solid #ddd; padding:10px;\"><strong>Uygulama yolu<\/strong><\/td>\n<td style=\"border:1px solid #ddd; padding:10px;\">Vajinadan<\/td>\n<td style=\"border:1px solid #ddd; padding:10px;\">Laparoskopik veya a\u00e7\u0131k kar\u0131n ameliyat\u0131yla<\/td>\n<\/tr>\n<tr>\n<td style=\"border:1px solid #ddd; padding:10px;\"><strong>\u0130lk tercih<\/strong><\/td>\n<td style=\"border:1px solid #ddd; padding:10px;\">\u00c7o\u011fu hastada<\/td>\n<td style=\"border:1px solid #ddd; padding:10px;\">Se\u00e7ilmi\u015f hastalarda<\/td>\n<\/tr>\n<tr>\n<td style=\"border:1px solid #ddd; padding:10px;\"><strong>Uygulama zaman\u0131<\/strong><\/td>\n<td style=\"border:1px solid #ddd; padding:10px;\">Genellikle gebelik s\u0131ras\u0131nda<\/td>\n<td style=\"border:1px solid #ddd; padding:10px;\">Tercihen gebelik \u00f6ncesi veya ilk trimester<\/td>\n<\/tr>\n<tr>\n<td style=\"border:1px solid #ddd; padding:10px;\"><strong>Cerrahi y\u00fck<\/strong><\/td>\n<td style=\"border:1px solid #ddd; padding:10px;\">Daha d\u00fc\u015f\u00fck<\/td>\n<td style=\"border:1px solid #ddd; padding:10px;\">Daha y\u00fcksek<\/td>\n<\/tr>\n<tr>\n<td style=\"border:1px solid #ddd; padding:10px;\"><strong>Diki\u015fin \u00e7\u0131kar\u0131lmas\u0131<\/strong><\/td>\n<td style=\"border:1px solid #ddd; padding:10px;\">Genellikle 36\u201337. haftada<\/td>\n<td style=\"border:1px solid #ddd; padding:10px;\">\u00c7o\u011funlukla \u00e7\u0131kar\u0131lmaz<\/td>\n<\/tr>\n<tr>\n<td style=\"border:1px solid #ddd; padding:10px;\"><strong>Do\u011fum \u015fekli<\/strong><\/td>\n<td style=\"border:1px solid #ddd; padding:10px;\">Vajinal do\u011fum m\u00fcmk\u00fcn olabilir<\/td>\n<td style=\"border:1px solid #ddd; padding:10px;\"><strong>Sezaryen gerekir<\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n<p>Y\u00f6ntem se\u00e7ilirken \u00f6nceki gebeli\u011fin ka\u00e7\u0131nc\u0131 haftada ve nas\u0131l sonland\u0131\u011f\u0131, daha \u00f6nce serklaj uygulan\u0131p uygulanmad\u0131\u011f\u0131, rahim a\u011fz\u0131n\u0131n anatomisi ve ge\u00e7irilmi\u015f ameliyatlar birlikte de\u011ferlendirilir.<\/p>\n\n<h2><span class=\"ez-toc-section\" id=\"i-16\"><\/span>Serklaj gebeli\u011fin ka\u00e7\u0131nc\u0131 haftas\u0131na kadar yap\u0131labilir?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n<p>Serklaj\u0131n uygulanma zaman\u0131, serklaj\u0131n yap\u0131lma nedenine g\u00f6re de\u011fi\u015fir.<\/p>\n\n<ul>\n<li><strong>\u00d6yk\u00fcye dayal\u0131 planl\u0131 serklaj:<\/strong> Genellikle 12\u201314. haftalarda yap\u0131l\u0131r.<\/li>\n<li><strong>Ultrasona dayal\u0131 serklaj:<\/strong> \u00c7o\u011funlukla 24. gebelik haftas\u0131ndan \u00f6nce uygulan\u0131r.<\/li>\n<li><strong>Fizik muayeneye dayal\u0131 acil serklaj:<\/strong> Kan\u0131tlar\u0131n en g\u00fc\u00e7l\u00fc oldu\u011fu d\u00f6nem 24. haftadan \u00f6ncedir.<\/li>\n<li><strong>Abdominal serklaj:<\/strong> Tercihen gebelik \u00f6ncesinde veya ilk trimesterde uygulan\u0131r.<\/li>\n<\/ul>\n\n<p>ACOG, do\u011fum eylemi, su gelmesi veya rahim i\u00e7i enfeksiyon bulunmamas\u0131 ko\u015fuluyla 24. haftadan \u00f6nce acil serklaj\u0131n de\u011ferlendirilebilece\u011fini belirtmektedir. <a href=\"https:\/\/www.acog.org\/clinical\/clinical-guidance\/obstetric-care-consensus\/articles\/2017\/10\/periviable-birth\" target=\"_blank\" rel=\"noopener noreferrer\">ACOG periviabilite rehberi<\/a><\/p>\n\n<p>RCOG\u2019ye g\u00f6re vajinal serklaj genellikle <strong>12\u201324. gebelik haftalar\u0131 aras\u0131nda<\/strong> uygulan\u0131r. Baz\u0131 \u00e7ok se\u00e7ilmi\u015f hastalarda daha ileri haftalarda d\u00fc\u015f\u00fcn\u00fclebilse de bu d\u00f6nemdeki bilimsel kan\u0131tlar daha s\u0131n\u0131rl\u0131d\u0131r. <a href=\"https:\/\/www.rcog.org.uk\/for-the-public\/browse-our-patient-information\/cervical-stitch\/\" target=\"_blank\" rel=\"noopener noreferrer\">RCOG servikal serklaj bilgilendirmesi<\/a><\/p>\n\n<h2><span class=\"ez-toc-section\" id=\"i-17\"><\/span>Servikal yetmezlikte enfeksiyon neden \u00f6nemlidir?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n<p>Rahim a\u011fz\u0131 ve servikal mukus t\u0131kac\u0131, vajinadaki mikroorganizmalar\u0131n rahim i\u00e7ine do\u011fru ilerlemesini \u00f6nleyen do\u011fal bir bariyer g\u00f6revi g\u00f6r\u00fcr.<\/p>\n\n<p>Rahim a\u011fz\u0131n\u0131n k\u0131salmas\u0131 veya a\u00e7\u0131lmas\u0131 bu bariyerin i\u015flevini bozarak mikroorganizmalar\u0131n rahim i\u00e7ine do\u011fru ilerlemesini kolayla\u015ft\u0131rabilir.<\/p>\n\n<p>Enfeksiyon ile servikal yetmezlik aras\u0131nda \u00e7ift y\u00f6nl\u00fc bir ili\u015fki bulunabilir:<\/p>\n\n<ul>\n<li>Rahim a\u011fz\u0131n\u0131n a\u00e7\u0131lmas\u0131, yukar\u0131 do\u011fru ilerleyen enfeksiyon riskini art\u0131rabilir.<\/li>\n<li>Rahim i\u00e7i enfeksiyon ve inflamasyon serviksin k\u0131salmas\u0131na neden olabilir.<\/li>\n<li>Enfeksiyon, fetal zarlar\u0131 zay\u0131flatarak su kesesinin erken a\u00e7\u0131lmas\u0131na yol a\u00e7abilir.<\/li>\n<li>Koryoamniyonit, anne enfeksiyonu, fetal enfeksiyon ve erken do\u011fum riski artabilir.<\/li>\n<li>Aktif enfeksiyon varl\u0131\u011f\u0131nda serklaj uygulanmas\u0131, enfeksiyonun rahim i\u00e7inde ilerlemesine neden olabilir.<\/li>\n<\/ul>\n\n<p>RCOG, serklaj\u0131n yaln\u0131zca rahim a\u011fz\u0131na mekanik destek sa\u011flamad\u0131\u011f\u0131n\u0131; servikal uzunluk ve mukus t\u0131kac\u0131n\u0131n yukar\u0131 do\u011fru ilerleyen enfeksiyona kar\u015f\u0131 olu\u015fturdu\u011fu bariyerin korunmas\u0131na da katk\u0131da bulunabilece\u011fini belirtmektedir. <a href=\"https:\/\/www.rcog.org.uk\/guidance\/browse-all-guidance\/green-top-guidelines\/cervical-cerclage-green-top-guideline-no-75\/\" target=\"_blank\" rel=\"noopener noreferrer\">RCOG Servikal Serklaj K\u0131lavuzu<\/a><\/p>\n\n<h2><span class=\"ez-toc-section\" id=\"i-18\"><\/span>Serklaj \u00f6ncesinde enfeksiyon nas\u0131l de\u011ferlendirilir?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n<p>\u00d6zellikle acil serklaj d\u00fc\u015f\u00fcn\u00fclen hastalarda enfeksiyon olas\u0131l\u0131\u011f\u0131 dikkatle ara\u015ft\u0131r\u0131l\u0131r. De\u011ferlendirme \u015fu y\u00f6ntemleri i\u00e7erebilir:<\/p>\n\n<ul>\n<li>Ate\u015f, kar\u0131n a\u011fr\u0131s\u0131 ve k\u00f6t\u00fc kokulu ak\u0131nt\u0131n\u0131n sorgulanmas\u0131<\/li>\n<li>Anne ate\u015fi ve nabz\u0131n\u0131n \u00f6l\u00e7\u00fclmesi<\/li>\n<li>Spekulum muayenesi<\/li>\n<li>Kan testleri<\/li>\n<li>Gerekti\u011finde vajinal veya servikal \u00f6rneklerin incelenmesi<\/li>\n<li>Se\u00e7ilmi\u015f acil vakalarda amniyosentez<\/li>\n<\/ul>\n\n<p>Tek bir kan testi veya vajinal k\u00fclt\u00fcr, rahim i\u00e7i enfeksiyonu her zaman kesin olarak d\u0131\u015flayamaz. Bulgular\u0131n birlikte de\u011ferlendirilmesi gerekir.<\/p>\n\n<p><strong>Aktif enfeksiyon, d\u00fczenli rahim kas\u0131lmalar\u0131, belirgin kanama veya su kesesinin a\u00e7\u0131lmas\u0131 durumlar\u0131nda serklaj \u00e7o\u011funlukla \u00f6nerilmez.<\/strong><\/p>\n\n<h2><span class=\"ez-toc-section\" id=\"i-19\"><\/span>Serklaj ameliyat\u0131 nas\u0131l yap\u0131l\u0131r?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n<p>Transvajinal serklaj genellikle ameliyathane ko\u015fullar\u0131nda, spinal veya genel anestezi alt\u0131nda ger\u00e7ekle\u015ftirilir. Vajinal yoldan rahim a\u011fz\u0131na ula\u015f\u0131larak serviksin \u00e7evresine diki\u015f yerle\u015ftirilir.<\/p>\n\n<p>\u0130\u015flem \u00e7o\u011funlukla bir saatten k\u0131sa s\u00fcrer. Hastan\u0131n klinik durumuna ba\u011fl\u0131 olarak ayn\u0131 g\u00fcn veya ertesi g\u00fcn taburculuk m\u00fcmk\u00fcn olabilir.<\/p>\n\n<p>Abdominal serklaj ise genel anestezi alt\u0131nda laparoskopik veya a\u00e7\u0131k cerrahiyle uygulan\u0131r. \u0130yile\u015fme s\u00fcreci vajinal serklaja g\u00f6re daha uzun olabilir.<\/p>\n\n<h2><span class=\"ez-toc-section\" id=\"i-20\"><\/span>Serklaj\u0131n riskleri nelerdir?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n<p>Serklaj genellikle g\u00fcvenli bir i\u015flem olmakla birlikte \u015fu komplikasyonlar g\u00f6r\u00fclebilir:<\/p>\n\n<ul>\n<li>Vajinal kanama<\/li>\n<li>Enfeksiyon<\/li>\n<li>Su kesesinin erken a\u00e7\u0131lmas\u0131<\/li>\n<li>Rahim kas\u0131lmalar\u0131<\/li>\n<li>Rahim a\u011fz\u0131nda yaralanma<\/li>\n<li>Diki\u015fin yer de\u011fi\u015ftirmesi<\/li>\n<li>Mesane yaralanmas\u0131<\/li>\n<li>Serklaja ra\u011fmen erken do\u011fum veya gebelik kayb\u0131<\/li>\n<\/ul>\n\n<p>Planl\u0131 ve acil serklajlar\u0131n risk d\u00fczeyi ayn\u0131 de\u011fildir. Rahim a\u011fz\u0131n\u0131n a\u00e7\u0131lm\u0131\u015f ve su kesesinin a\u015fa\u011f\u0131 do\u011fru ilerlemi\u015f oldu\u011fu <strong>acil vakalarda komplikasyon riski daha y\u00fcksek olabilir.<\/strong><\/p>\n\n<h2><span class=\"ez-toc-section\" id=\"i-21\"><\/span>Serklaj hangi durumlarda uygulanmayabilir?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n<p>A\u015fa\u011f\u0131daki durumlarda serklaj uygun olmayabilir:<\/p>\n\n<ul>\n<li>Aktif rahim i\u00e7i veya vajinal enfeksiyon<\/li>\n<li>D\u00fczenli rahim kas\u0131lmalar\u0131 ve aktif do\u011fum eylemi<\/li>\n<li>Belirgin vajinal kanama<\/li>\n<li>Su kesesinin a\u00e7\u0131lm\u0131\u015f olmas\u0131<\/li>\n<li>Gebeli\u011fin devam\u0131n\u0131n t\u0131bben uygun olmad\u0131\u011f\u0131 baz\u0131 durumlar<\/li>\n<\/ul>\n\n<p>\u00c7o\u011ful gebeliklerde yaln\u0131zca k\u0131sa serviks bulunmas\u0131na dayanarak rutin serklaj yap\u0131lmas\u0131 \u00f6nerilmez. Karar hastan\u0131n klinik durumuna g\u00f6re bireyselle\u015ftirilmelidir.<\/p>\n\n<h2><span class=\"ez-toc-section\" id=\"i-22\"><\/span>Serklaj sonras\u0131nda nelere dikkat edilmelidir?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n<p>\u0130\u015flemden sonra birka\u00e7 g\u00fcn hafif kramp, lekelenme veya vajinal ak\u0131nt\u0131 g\u00f6r\u00fclebilir. A\u011f\u0131r fiziksel aktivite, cinsel ili\u015fki ve g\u00fcnl\u00fck ya\u015fama d\u00f6n\u00fc\u015f konusunda i\u015flemi ger\u00e7ekle\u015ftiren hekimin \u00f6nerileri takip edilmelidir.<\/p>\n\n<p>A\u015fa\u011f\u0131daki belirtilerde <strong>zaman kaybetmeden sa\u011fl\u0131k kurulu\u015funa ba\u015fvurulmal\u0131d\u0131r:<\/strong><\/p>\n\n<ul>\n<li>D\u00fczenli veya giderek artan kas\u0131lmalar<\/li>\n<li>\u015eiddetli kar\u0131n ya da bel a\u011fr\u0131s\u0131<\/li>\n<li>Devam eden veya yo\u011fun vajinal kanama<\/li>\n<li>Su gelmesi<\/li>\n<li>Ate\u015f<\/li>\n<li>K\u00f6t\u00fc kokulu veya ye\u015fil vajinal ak\u0131nt\u0131<\/li>\n<li>Bebe\u011fin hareketlerinde belirgin azalma<\/li>\n<\/ul>\n\n<p><strong>Uzun s\u00fcreli rutin yatak istirahati erken do\u011fumu \u00f6nlemek amac\u0131yla \u00f6nerilmez.<\/strong><\/p>\n\n<h2><span class=\"ez-toc-section\" id=\"i-23\"><\/span>Serklaj diki\u015fi ne zaman \u00e7\u0131kar\u0131l\u0131r?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n<p>Transvajinal serklaj diki\u015fi \u00e7o\u011funlukla gebeli\u011fin <strong>36\u201337. haftalar\u0131nda<\/strong> \u00e7\u0131kar\u0131l\u0131r. Do\u011fum eyleminin ba\u015flamas\u0131 veya su kesesinin a\u00e7\u0131lmas\u0131 gibi durumlarda diki\u015fin daha erken \u00e7\u0131kar\u0131lmas\u0131 gerekebilir.<\/p>\n\n<p>Diki\u015fin \u00e7\u0131kar\u0131lmas\u0131ndan sonra ba\u015fka bir engel bulunmuyorsa <strong>vajinal do\u011fum m\u00fcmk\u00fcn olabilir.<\/strong><\/p>\n\n<p>Transabdominal serklaj ise \u00e7o\u011funlukla \u00e7\u0131kar\u0131lmaz. <strong>Do\u011fum sezaryenle ger\u00e7ekle\u015ftirilir<\/strong> ve diki\u015f sonraki gebelikler i\u00e7in yerinde b\u0131rak\u0131labilir.<\/p>\n\n<h2><span class=\"ez-toc-section\" id=\"i-24\"><\/span>Sonraki gebelikte yeniden serklaj gerekir mi?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n<p>Bir gebelikte serklaj uygulanm\u0131\u015f olmas\u0131, sonraki her gebelikte mutlaka yeniden serklaj yap\u0131laca\u011f\u0131 anlam\u0131na gelmez.<\/p>\n\n<p>Karar verilirken \u015fu fakt\u00f6rler de\u011ferlendirilir:<\/p>\n\n<ul>\n<li>\u00d6nceki serklaj\u0131n uygulanma nedeni<\/li>\n<li>Kullan\u0131lan serklaj y\u00f6ntemi<\/li>\n<li>Do\u011fumun ger\u00e7ekle\u015fti\u011fi gebelik haftas\u0131<\/li>\n<li>\u00d6nceki gebeli\u011fin nas\u0131l sonu\u00e7land\u0131\u011f\u0131<\/li>\n<li>Rahim a\u011fz\u0131n\u0131n mevcut anatomisi<\/li>\n<li>Vajinal serklaj\u0131n ba\u015far\u0131l\u0131 olup olmad\u0131\u011f\u0131<\/li>\n<\/ul>\n\n<p>Daha \u00f6nce ikinci trimester gebelik kayb\u0131, \u00e7ok erken do\u011fum veya serklaj \u00f6yk\u00fcs\u00fc bulunan kad\u0131nlar\u0131n m\u00fcmk\u00fcnse <strong>gebelikten \u00f6nce ya da gebeli\u011fin erken haftalar\u0131nda de\u011ferlendirilmesi<\/strong> \u00f6nemlidir.<\/p>\n\n<h2><span class=\"ez-toc-section\" id=\"i-25\"><\/span>Servikal yetmezlik ve serklaj hakk\u0131nda s\u0131k sorulan sorular<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n<h3>Rahim a\u011fz\u0131 yetmezli\u011fi gebelikte belli olur mu?<\/h3>\n\n<p>Evet. \u00d6nceki gebelik \u00f6yk\u00fcs\u00fc, transvajinal ultrasonla serviks \u00f6l\u00e7\u00fcm\u00fc ve fizik muayene sayesinde gebelik s\u0131ras\u0131nda saptanabilir. Ancak baz\u0131 hastalarda ilk belirti a\u011fr\u0131s\u0131z rahim a\u011fz\u0131 a\u00e7\u0131lmas\u0131 veya ge\u00e7 gebelik kayb\u0131 olabilir.<\/p>\n\n<h3>Servikal yetmezlik tamamen \u00f6nlenebilir mi?<\/h3>\n\n<p>Her vakay\u0131 \u00f6nlemek m\u00fcmk\u00fcn de\u011fildir. Riskli hastalar\u0131n erken belirlenmesi, seri serviks \u00f6l\u00e7\u00fcmleri, uygun hastalarda progesteron veya serklaj uygulanmas\u0131 ve t\u00fcp bebek tedavisinde tek embriyo transferinin tercih edilmesi riski azaltabilir.<\/p>\n\n<h3>Serviks 25 mm\u2019nin alt\u0131ndaysa mutlaka serklaj gerekir mi?<\/h3>\n\n<p><strong>Hay\u0131r.<\/strong> Yirmi be\u015f milimetre ve alt\u0131 k\u0131sa serviks olarak kabul edilebilir; ancak \u00f6nceki erken do\u011fum \u00f6yk\u00fcs\u00fc olmayan ve rahim a\u011fz\u0131nda a\u00e7\u0131lma bulunmayan hastalarda ilk yakla\u015f\u0131m \u00e7o\u011funlukla vajinal progesterondur.<\/p>\n\n<h3>Serviks 10 mm\u2019nin alt\u0131ndaysa serklaj yap\u0131l\u0131r m\u0131?<\/h3>\n\n<p>Progesteron tedavisine ra\u011fmen serviks 10 mm\u2019nin alt\u0131na kadar k\u0131salm\u0131\u015fsa serklaj bireysel olarak de\u011ferlendirilebilir. Ancak gebelik haftas\u0131, rahim a\u011fz\u0131nda a\u00e7\u0131lma ve enfeksiyon bulgular\u0131 da dikkate al\u0131nmal\u0131d\u0131r.<\/p>\n\n<h3>Serklaj erken do\u011fumu kesin olarak \u00f6nler mi?<\/h3>\n\n<p><strong>Hay\u0131r.<\/strong> Serklaj b\u00fct\u00fcn erken do\u011fumlar\u0131 veya gebelik kay\u0131plar\u0131n\u0131 kesin olarak \u00f6nlemez. Uygun hastada riski azaltarak gebeli\u011fin daha ileri haftalara ula\u015fmas\u0131na yard\u0131mc\u0131 olabilir.<\/p>\n\n<h3>Servikal yetmezlikte \u00e7ift embriyo transferi yap\u0131l\u0131r m\u0131?<\/h3>\n\n<p>Mutlak bir yasak olarak tan\u0131mlanmasa da servikal yetmezlik veya ciddi erken do\u011fum \u00f6yk\u00fcs\u00fc bulunan hastalarda <strong>\u00e7ift embriyo transferi \u00f6nerilmez.<\/strong> \u00c7o\u011ful gebelik riskini azaltmak amac\u0131yla tek embriyo transferi \u00f6ncelikli olarak de\u011ferlendirilmelidir.<\/p>\n\n<h3>\u0130kiz gebelikte rutin serklaj yap\u0131l\u0131r m\u0131?<\/h3>\n\n<p><strong>Hay\u0131r.<\/strong> \u0130kiz gebelikte yaln\u0131zca k\u0131sa serviks bulunmas\u0131na dayanarak rutin serklaj \u00f6nerilmez. Belirgin servikal a\u00e7\u0131lma gibi \u00f6zel durumlarda karar bireyselle\u015ftirilebilir.<\/p>\n\n<h3>Serklaj ka\u00e7\u0131nc\u0131 haftaya kadar yap\u0131l\u0131r?<\/h3>\n\n<p>Planl\u0131 ve ultrasona dayal\u0131 vajinal serklajlar \u00e7o\u011funlukla <strong>24. gebelik haftas\u0131ndan \u00f6nce<\/strong> uygulan\u0131r. Acil serklaj i\u00e7in de kan\u0131tlar\u0131n en g\u00fc\u00e7l\u00fc oldu\u011fu d\u00f6nem 24. haftadan \u00f6ncedir.<\/p>\n\n<h3>Serklaj sonras\u0131 normal do\u011fum yap\u0131labilir mi?<\/h3>\n\n<p>Transvajinal serklaj diki\u015fi \u00e7\u0131kar\u0131ld\u0131ktan sonra, ba\u015fka bir engel bulunmuyorsa vajinal do\u011fum m\u00fcmk\u00fcnd\u00fcr. Transabdominal serklaj uygulanan hastalarda ise <strong>do\u011fum sezaryenle ger\u00e7ekle\u015ftirilir.<\/strong><\/p>\n\n<h3>Serklaj sonras\u0131 yatak istirahati gerekir mi?<\/h3>\n\n<p>Uzun s\u00fcreli rutin yatak istirahati genellikle \u00f6nerilmez. Aktivite d\u00fczeyi hastan\u0131n klinik durumuna ve hekimin \u00f6nerilerine g\u00f6re belirlenmelidir.<\/p>\n\n<h2><span class=\"ez-toc-section\" id=\"i-26\"><\/span>\u0417\u0430\u043a\u043b\u044e\u0447\u0435\u043d\u0438\u0435<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n<p>Servikal yetmezlik, erken fark edildi\u011finde ki\u015fiye \u00f6zel takip ve tedaviyle y\u00f6netilebilen \u00f6nemli bir gebelik komplikasyonudur. Serklaj\u0131n uygulanma zaman\u0131, y\u00f6ntemi ve cerrahi tekni\u011fi her hasta i\u00e7in ayn\u0131 de\u011fildir.<\/p>\n\n<p>\u00c7o\u011fu hastada <strong>transvajinal serklaj<\/strong> yeterli olurken, daha \u00f6nce vajinal serklaja ra\u011fmen \u00e7ok erken do\u011fum ya\u015fam\u0131\u015f veya vajinal serklaj uygulanmas\u0131 m\u00fcmk\u00fcn olmayan se\u00e7ilmi\u015f hastalarda <strong>abdominal serklaj<\/strong> de\u011ferlendirilebilir.<\/p>\n\n<p>Servikal uzunlu\u011fun <strong>25 mm veya alt\u0131nda olmas\u0131 k\u0131sa serviks<\/strong> olarak kabul edilse de serklaj karar\u0131 yaln\u0131zca bu \u00f6l\u00e7\u00fcme g\u00f6re verilmez. \u00d6nceki gebelik \u00f6yk\u00fcs\u00fc, servikal a\u00e7\u0131lma, enfeksiyon bulgular\u0131 ve gebelik haftas\u0131 birlikte de\u011ferlendirilmelidir.<\/p>\n\n<p>Servikal yetmezlik veya ciddi erken do\u011fum \u00f6yk\u00fcs\u00fc bulunan t\u00fcp bebek hastalar\u0131nda \u00e7o\u011ful gebelikten ka\u00e7\u0131nmak amac\u0131yla <strong>tek embriyo transferi \u00f6ncelikli olarak d\u00fc\u015f\u00fcn\u00fclmelidir.<\/strong><\/p>\n\n<p>Daha \u00f6nce ikinci trimester gebelik kayb\u0131, \u00e7ok erken do\u011fum veya servikal serklaj \u00f6yk\u00fcn\u00fcz varsa gebelikten \u00f6nce ya da gebeli\u011fin erken haftalar\u0131nda ayr\u0131nt\u0131l\u0131 de\u011ferlendirme i\u00e7in <strong>kad\u0131n hastal\u0131klar\u0131 ve do\u011fum uzman\u0131na ba\u015fvurabilirsiniz.<\/strong><\/p>\n\n<hr \/>\n\n<p><em>Yazar ve t\u0131bbi de\u011ferlendirme:<\/em><br \/>\n<strong>\u041e\u043f. \u0434-\u0440 \u0421\u043e\u043d\u0435\u0440 \u0414\u044e\u0437\u0433\u044e\u043d\u0435\u0440<\/strong><br \/>\n<em>Kad\u0131n Hastal\u0131klar\u0131, Do\u011fum ve T\u00fcp Bebek Uzman\u0131<\/em><br \/>\n<em>Son g\u00fcncelleme: 28 A\u011fustos 2026<\/em><\/p>\n\n<p><em>Bu i\u00e7erik genel bilgilendirme amac\u0131yla haz\u0131rlanm\u0131\u015ft\u0131r. Muayene, tan\u0131 veya ki\u015fiye \u00f6zel tedavi \u00f6nerisinin yerine ge\u00e7mez.<\/em><\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div><\/div><\/div><\/div><\/div><div      class=\"vc_row wpb_row section vc_row-fluid\" style=' text-align:left;'><div class=\"full_section_inner clearfix\"><div class=\"blog-detay wpb_column vc_column_container vc_col-sm-12\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><\/div><\/div><\/div><\/div><\/div><div      class=\"vc_row wpb_row section vc_row-fluid  sizi-arayalim vc_custom_1748634241618\" style=' text-align:left;'><div class=\"full_section_inner clearfix\"><div class=\"wpb_column vc_column_container vc_col-sm-12\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div      class=\"vc_row wpb_row section vc_row-fluid vc_inner\" style=' text-align:left;'><div class=\"full_section_inner clearfix\"><div class=\"wpb_column vc_column_container vc_col-sm-12\"><div class=\"vc_column-inner vc_custom_1746548174605\"><div class=\"wpb_wrapper\">\n\t<div class=\"wpb_text_column wpb_content_element\">\n\t\t<div class=\"wpb_wrapper\">\n\t\t\t<h2><span class=\"ez-toc-section\" id=\"i-27\"><\/span><span style=\"color: #ffffff;\">\u041d\u0435\u043a\u0430 \u0432\u0438 \u0441\u0435 \u043e\u0431\u0430\u0434\u0438\u043c<\/span><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\t\t<\/div>\n\t<\/div><div class=\"vc_empty_space\"  style=\"height: 15px\" >\n\t<span class=\"vc_empty_space_inner\">\n\t\t<span class=\"empty_space_image\"  ><\/span>\n\t<\/span>\n<\/div>\n\t<div class=\"wpb_text_column wpb_content_element\">\n\t\t<div class=\"wpb_wrapper\">\n\t\t\t<p><span style=\"color: #ffffff;\">\u041d\u0435\u043a\u0430 \u0441\u0435 \u0441\u0432\u044a\u0440\u0436\u0435\u043c \u0441 \u0432\u0430\u0441 \u0431\u044a\u0440\u0437\u043e \u043f\u043e \u0442\u0435\u043c\u0438\u0442\u0435, \u043f\u043e \u043a\u043e\u0438\u0442\u043e \u0438\u0441\u043a\u0430\u0442\u0435 \u0434\u0430 \u0441\u0435 \u043a\u043e\u043d\u0441\u0443\u043b\u0442\u0438\u0440\u0430\u043c\u0435.<\/span><\/p>\n\n\t\t<\/div>\n\t<\/div><div class=\"vc_empty_space\"  style=\"height: 15px\" >\n\t<span class=\"vc_empty_space_inner\">\n\t\t<span class=\"empty_space_image\"  ><\/span>\n\t<\/span>\n<\/div>\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1517-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"1517\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/bg\/wp-json\/wp\/v2\/posts\/3958#wpcf7-f1517-o1\" method=\"post\" class=\"wpcf7-form init cf7_custom_style_1\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\" data-trp-original-action=\"\/bg\/wp-json\/wp\/v2\/posts\/3958#wpcf7-f1517-o1\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"1517\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.6\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1517-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<div class=\"mobil-full-form\"  style=\"width:70%; margin-bottom:10px;\">\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"phonetext-184\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-phonetext wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-phonetext\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u0422\u0435\u043b\u0435\u0444\u043e\u043d\" value=\"\" type=\"text\" name=\"phonetext-184\" \/><input type=\"hidden\" name=\"phonetext-184-country-code\" class=\"wpcf7-phonetext-country-code\" \/><\/span>\n\t<\/p>\n<\/div>\n<div class=\"mobil-full-form\"  style=\"width:27%; margin:0 auto;\">\n\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"\u0418\u0437\u043f\u0440\u0430\u0442\u0438\" \/>\n\t<\/p>\n<\/div>\n<input class=\"wpcf7-form-control wpcf7-hidden\" id=\"current-page-url\" value=\"\" type=\"hidden\" name=\"current-page-url\" \/><input type='hidden' class='wpcf7-pum' value='{\"closepopup\":false,\"closedelay\":0,\"openpopup\":false,\"openpopup_id\":0}' \/><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<input type=\"hidden\" name=\"trp-form-language\" value=\"bg\"\/><\/form>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div      class=\"vc_row wpb_row section vc_row-fluid  vc_custom_1747683896913\" style=' text-align:left;'><div class=\"full_section_inner clearfix\"><div class=\"wpb_column vc_column_container vc_col-sm-12\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div      class=\"vc_row wpb_row section vc_row-fluid vc_inner  detay-info\" style=' text-align:left;'><div class=\"full_section_inner clearfix\"><div class=\"wpb_column vc_column_container vc_col-sm-2\"><div class=\"vc_column-inner vc_custom_1746548174605\"><div class=\"wpb_wrapper\">\n\t<div class=\"wpb_single_image wpb_content_element vc_align_left\">\n\t\t<div class=\"wpb_wrapper\">\n\t\t\t\n\t\t\t<div class=\"vc_single_image-wrapper   vc_box_border_grey\"><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/www.sonerduzguner.com\/wp-content\/uploads\/2025\/04\/blog-image-2.jpg\" class=\"vc_single_image-img attachment-thumbnail\" alt=\"\" title=\"blog-image-2\" srcset=\"https:\/\/www.sonerduzguner.com\/wp-content\/uploads\/2025\/04\/blog-image-2.jpg 150w, https:\/\/www.sonerduzguner.com\/wp-content\/uploads\/2025\/04\/blog-image-2-12x12.jpg 12w\" sizes=\"auto, (max-width: 150px) 100vw, 150px\" \/><\/div>\n\t\t<\/div>\n\t<\/div>\n<div class=\"vc_empty_space\"  style=\"height: 15px\" >\n\t<span class=\"vc_empty_space_inner\">\n\t\t<span class=\"empty_space_image\"  ><\/span>\n\t<\/span>\n<\/div><span class='q_social_icon_holder normal_social' ><a itemprop='url' href='#' target='_self'><i class=\"qode_icon_font_awesome fa fa-facebook fa-lg simple_social\" style=\"\" ><\/i><\/a><\/span><span class='q_social_icon_holder normal_social' ><a itemprop='url' href='#' target='_self'><i class=\"qode_icon_font_awesome fa fa-instagram fa-lg simple_social\" style=\"\" ><\/i><\/a><\/span><span class='q_social_icon_holder normal_social' ><a itemprop='url' href='#' target='_self'><i class=\"qode_icon_font_awesome fa fa-twitter fa-lg simple_social\" style=\"\" ><\/i><\/a><\/span><span class='q_social_icon_holder normal_social' ><a itemprop='url' href='#' target='_self'><i class=\"qode_icon_font_awesome fa fa-youtube fa-lg simple_social\" style=\"\" ><\/i><\/a><\/span><\/div><\/div><\/div><div class=\"blog-detay-bg wpb_column vc_column_container vc_col-sm-10 vc_col-has-fill\"><div class=\"vc_column-inner vc_custom_1746549654715\"><div class=\"wpb_wrapper\">\n\t<div class=\"wpb_text_column wpb_content_element\">\n\t\t<div class=\"wpb_wrapper\">\n\t\t\t<h4>Op. Dr. Soner D\u00dcZG\u00dcNER<\/h4>\n\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"wpb_text_column wpb_content_element  blog-detay-unvan\">\n\t\t<div class=\"wpb_wrapper\">\n\t\t\t<p>\u0421\u043f\u0435\u0446\u0438\u0430\u043b\u0438\u0441\u0442 \u043f\u043e \u0430\u043a\u0443\u0448\u0435\u0440\u0441\u0442\u0432\u043e \u0438 \u0433\u0438\u043d\u0435\u043a\u043e\u043b\u043e\u0433\u0438\u044f<\/p>\n\n\t\t<\/div>\n\t<\/div><div class=\"vc_empty_space\"  style=\"height: 5px\" >\n\t<span class=\"vc_empty_space_inner\">\n\t\t<span class=\"empty_space_image\"  ><\/span>\n\t<\/span>\n<\/div>\n\t<div class=\"wpb_text_column wpb_content_element  blog-detay-unvan-desc\">\n\t\t<div class=\"wpb_wrapper\">\n\t\t\t<p>\u0414-\u0440 \u0421\u043e\u043d\u0435\u0440 \u0414\u044e\u0437\u0433\u044e\u043d\u0435\u0440: \u041e\u0441\u0438\u0433\u0443\u0440\u044f\u0432\u0430 \u0434\u0438\u0430\u0433\u043d\u043e\u0441\u0442\u0438\u043a\u0430 \u0438 \u043b\u0435\u0447\u0435\u043d\u0438\u0435 \u0432 \u043e\u0431\u043b\u0430\u0441\u0442\u0438 \u043a\u0430\u0442\u043e \u0438\u043d \u0432\u0438\u0442\u0440\u043e \u043e\u043f\u043b\u043e\u0436\u0434\u0430\u043d\u0435, \u0436\u0435\u043d\u0441\u043a\u043e \u0437\u0434\u0440\u0430\u0432\u0435, \u0431\u0435\u0437\u043f\u043b\u043e\u0434\u0438\u0435, \u0433\u0438\u043d\u0435\u043a\u043e\u043b\u043e\u0433\u0438\u0447\u043d\u0430 \u0445\u0438\u0440\u0443\u0440\u0433\u0438\u044f \u0438 \u043f\u0440\u043e\u0441\u043b\u0435\u0434\u044f\u0432\u0430\u043d\u0435 \u043d\u0430 \u0431\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442.<\/p>\n\n\t\t<\/div>\n\t<\/div><div class=\"vc_empty_space\"  style=\"height: 15px\" >\n\t<span class=\"vc_empty_space_inner\">\n\t\t<span class=\"empty_space_image\"  ><\/span>\n\t<\/span>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>Servikal yetmezlik, rahim a\u011fz\u0131n\u0131n gebelik s\u0131ras\u0131nda erken k\u0131salmas\u0131 veya a\u00e7\u0131lmas\u0131 sonucu ikinci trimester gebelik kayb\u0131 ve erken do\u011fum riskini art\u0131rabilen bir durumdur. Tan\u0131da \u00f6nceki gebelik \u00f6yk\u00fcs\u00fc, transvajinal ultrasonla serviks uzunlu\u011fu \u00f6l\u00e7\u00fcm\u00fc ve fizik muayene birlikte de\u011ferlendirilir.<\/p>\n<p>Tedavi her hasta i\u00e7in ayn\u0131 de\u011fildir. Vajinal progesteron, transvajinal serklaj veya se\u00e7ilmi\u015f hastalarda transabdominal serklaj uygulanabilir. Serklaj karar\u0131 yaln\u0131zca serviks uzunlu\u011funa g\u00f6re de\u011fil; gebelik haftas\u0131, \u00f6nceki erken do\u011fum veya gebelik kayb\u0131 \u00f6yk\u00fcs\u00fc, rahim a\u011fz\u0131nda a\u00e7\u0131lma ve enfeksiyon bulgular\u0131 dikkate al\u0131narak verilir.<\/p>\n<p>Servikal yetmezlik veya ciddi erken do\u011fum \u00f6yk\u00fcs\u00fc bulunan t\u00fcp bebek hastalar\u0131nda \u00e7o\u011ful gebelik riskini azaltmak amac\u0131yla tek embriyo transferi \u00f6ncelikli olarak de\u011ferlendirilmelidir.<\/p>","protected":false},"author":1,"featured_media":3965,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-3958","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blog-icerikleri"],"_links":{"self":[{"href":"https:\/\/www.sonerduzguner.com\/bg\/wp-json\/wp\/v2\/posts\/3958","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.sonerduzguner.com\/bg\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.sonerduzguner.com\/bg\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.sonerduzguner.com\/bg\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.sonerduzguner.com\/bg\/wp-json\/wp\/v2\/comments?post=3958"}],"version-history":[{"count":5,"href":"https:\/\/www.sonerduzguner.com\/bg\/wp-json\/wp\/v2\/posts\/3958\/revisions"}],"predecessor-version":[{"id":3964,"href":"https:\/\/www.sonerduzguner.com\/bg\/wp-json\/wp\/v2\/posts\/3958\/revisions\/3964"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.sonerduzguner.com\/bg\/wp-json\/wp\/v2\/media\/3965"}],"wp:attachment":[{"href":"https:\/\/www.sonerduzguner.com\/bg\/wp-json\/wp\/v2\/media?parent=3958"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.sonerduzguner.com\/bg\/wp-json\/wp\/v2\/categories?post=3958"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.sonerduzguner.com\/bg\/wp-json\/wp\/v2\/tags?post=3958"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}