|Table of Contents|

Relationship of total bile acid level and timing of termination with perinatal outcomes in intrahepatic cholestasis of pregnancy
 

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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

Issue:
2018年第11期
Page:
1028-1032
Research Field:
临床医学
Publishing date:

Info

Title:

Relationship of total bile acid level and timing of termination with perinatal outcomes in intrahepatic cholestasis of pregnancy
 

Author(s):

XIAO Fenglian ZHENG Yingru

Department of Gynecology and Obstetrics, Institute of Surgery Research, Third Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, China

Keywords:

pregnancy complications intrahepatic cholestasis total bile acid termination perinatal outcomes

PACS:
R446; R714.25; R722
DOI:
-
Abstract:

Objective    To determine the association of the perinatal outcomes with the level of total bile acid (TBA) and timing of termination in intrahepatic cholestasis of pregnancy (ICP). Methods    A retrospective study was conducted among 198 women suffering from ICP treated in our hospital from March 2013 to June 2017. According to the level of TBA, the women were divided into 3 groups, that is, 10~39.99 μmol/L (group Ⅰ), 40~99.99 μmol/L (group Ⅱ) and ≥100 μmol/L (group Ⅲ). On the basis of termination, the cases were also divided into 3 groups, <36 weeks gestation (group A), 36~36+6 weeks (group B), and ≥37 weeks gestation (group C). The adverse perinatal outcomes of low birth weight, meconium-stained amniotic fluid (MSAF), neonatal intensive care unit (NICU) admission, neonatal myocardial damage, pneumonia, hyperbilirubinemia, neonatal respiratory distress syndrome (NRDS) of perinatal infant were analyzed. Results    The incidence of adverse perinatal outcomes in group ⅠA was significantly higher than those of groups ⅠB and ⅠC (P<0.05). The incidence of low birth weight in group ⅠB was significantly higher than that in group ⅠC (P<0.05). The incidence of NICU admission in group ⅠB was lower than that in group ⅠC, but without statistical difference (P>0.05). The incidence of adverse perinatal outcomes in group ⅡA was notably higher than those in groups ⅡB and ⅡC (P<0.05). The incidences of low birth weight and recent complications in group ⅡB were higher than those in group ⅡC, but there was no significant difference (P>0.05). No newborns in groups ⅡB andⅡC entered in the NICU. The gestational age of onset in group Ⅲ was shorter than 34 weeks, and the incidence of adverse outcomes in the perinatal infants was higher when the gestational age was shorter than 36 weeks. Conclusion    When serum TBA ranged from 10 to 40 μmol/L, termination of 37 weeks gestation is recommended to decrease the adverse perinatal outcomes of ICP, and when the range was 40~100 μmol/L, 36 weeks gestation of termination is a strategy. While, for the women with TBA ≥100 μmol/L, termination should depend on maturation of the fetus.

References:

[1]REYES H. Sex hormones and bile acids in intrahepatic cholestasis of pregnancy[J]. Hepatology, 2008, 47(2): 376-379. DOI:10.1002/hep.22139.
[2]ABEDIN P, WEAVER J B, EGGINTON E. Intrahepatic cholestasis of pregnancy: prevalence and ethnic distribution[J]. Ethn Health, 1999,4(1/2):35-37. DOI:10.1080/13557859998173.
[3]LUO X L, ZHANG W Y. Obstetrical disease spectrum in China: an epidemiological study of 111,767 cases in 2011[J]. Chin Med J, 2015, 128(9): 1137-1146. DOI:10.4103/03666999.156076.
[4]余海燕, 姚强, 周容, 等. 妊娠晚期死胎相关危险因素分析[J]. 中华妇幼临床医学杂志(电子版), 2010, 6(1): 39-43. DOI: 10.3969/j.issn.16735250.2010.01.012.
YU H Y,YAO Q,ZHOU R, et al. Relative risk factor analysis on fetal death in the third trimester[J]. Chin J Obstet Gynecol Pediatr (Electron Ed), 2010,6(1):39-43. DOI: 10.3969/j.issn.16735250.2010.01.012.
[5]中华医学会妇产科学分会产科学组.妊娠期肝内胆汁淤积症诊疗指南(2015)[J].中华妇产科杂志,2015,50(7):481-485.DOI:10.3760/cma.j.issn.0529567x.2015.07.001.
Department of Obstetrics and Gynecology Branch of Study Group of the Chinese Medical Association. Guidebook for diagnosis and treatment of intrahepatic cholestasis of pregnancy(2015)[J]. Chin J Obstet Gynecol, 2015,50(7): 481-485.DOI:10.3760/cma.j.issn.0529567x.2015.07.001.
[6]谢幸.妇产科学[M]. 8版.北京:人民卫生出版社, 2013: 73-75.
XIE X. Obstetrics and gynecology[M].8th ed. Beijing: People’s Medical Publishing House, 2013:73-75.
[7]KAWAKITA T, PARIKH L I, RAMSEY P S, et al. Predictors of adverse neonatal outcomes in intrahepatic cholestasis of pregnancy[J]. Am J Obstet Gynecol, 2015, 213(4): 570-571. DOI:10.1016/j.ajog.2015.06.021.
[8]邵肖梅.实用新生儿学[M]. 4版.北京:人民卫生出版社,2011:273-274,395-398,401-402,561-563.
SHAO X M. Practice of neonatology[M]. 4th ed. Beijing: People’s Medical Publishing House, 2011:273-274, 395-398,401-402,561-563.
[9]BROUWERS L, KOSTER M P, PAGECHRISTIAENS G C, et al. Intrahepatic cholestasis of pregnancy: maternal and fetal outcomes associated with elevated bile acid levels[J]. Am J Obstet Gynecol, 2015, 212(1): 100-101. DOI:10.1016/j.ajog.2014.07.026.
[10]贺晶,陈璐,梁琤.妊娠期肝内胆汁淤积症发生死胎的临床因素分析[J].中华妇产科杂志,2011,46(5):333-337. DOI:10.3760/cma.j.issn.0529567x.2011.05.004.
HE J, CHEN L, LIANG C. Clinical analysis of fetal death cases in intrahepatic cholestasis of pregnancy[J]. Chin J Obstet Gynecol, 2011,46(5):333-337.DOI:10.3760/cma.j.issn. 0529567x.2011.05.004.
[11]喻玲,丁依玲,王长秀.妊娠期肝内胆汁淤积症胎儿胆汁酸水平与非表面活性物质相关性研究[J].中华妇产科杂志,2011,46(5)324-328.DOI :10.3760/cma.j.issn.0529567x.2011.05.002.
YU L,DING Y L,WANG C X. Relationship between total bile acid concentration and fetal pulmonary surfactant in intrahepatic cholestasis of pregnancy[J]. Chin J Obstet Gynecol,2011,46(5):324-328. DOI:10.3760/cma.j.issn.0529567x.2011.05.002.
[12]CAMPOS G A, GUERRA F A, ISRAEL E J. Effects of cholic acid infusion in fetal lambs[J]. Acta Obstet Gynecol Scand,1986,65(1):23-26. DOI:10.3109/00016348609158224.
[13]WIKSTRM SHEMER E, MARSCHALL H U, LUDVIGSSON J F, et al. Intrahepatic cholestasis of pregnancy and associated adverse pregnancy and fetal outcomes: a 12year populationbased cohort study[J]. BJOG, 2013, 120(6): 717-723. DOI:10.1111/14710528.12174.
[14]GEENES V, CHAPPELL L C, SEED P T, et al. Association of severe intrahepatic cholestasis of pregnancy with adverse pregnancy outcomes: a prospective populationbased casecontrol study[J]. Hepatology, 2014, 59(4): 1482-1491. DOI:10.1002/hep.26617.
[15]王晓东,彭冰,姚强,等.妊娠肝内胆汁淤积症1210例围生结局分析[J].中华医学杂志,2006,86(7):446-449.DOI: 10.3760/j:issn:03762491.2006.07.005.
WANG X D,PENG B,YAO Q,et al. Analysis of perinatal outcome in 1210 cases of intrahepatic cholestasis of pregnancy[J]. Natl Med J China, 2006,86(7):446-449.DOI: 10.3760/j:issn:03762491.2006.07.005.
[16]PULJIC A, KIM E, PAGE J, et al. The risk of infant and fetal death by each additional week of expectant management in intrahepatic cholestasis of pregnancy by gestational age[J]. Am J Obstet Gynecol, 2015, 212(5): 667-661. DOI:10.1016/j.ajog.2015.02.012.
[17]LO J O, SHAFFER B L, ALLEN A J, et al. Intrahepatic cholestasis of pregnancy and timing of delivery[J]. J Matern Fetal Neonatal Med, 2014, 28(18): 2254-2258. DOI:10.3109/14767058.2014.984605.
[18]CHAPPELL L C, GURUNG V, SEED P T, et al. Ursodeoxycholic acid versus placebo, and early term delivery versus expectant management, in women with intrahepatic cholestasis of pregnancy: semifactorial randomised clinical trial[J]. BMJ, 2012, 344: e3799.

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Last Update: 2018-06-14