İZOLE VE KOMPLİKE KOLESTAZLI GEBE KADINLARIN PERİNATAL SONUÇLARININ KARŞILAŞTIRILMASI Comparison of Perinatal Outcomes in Pregnant Women with Isolated and Complicated Cholestasis

Year 2020, Volume: 10 Issue: 1, 202 - 206, 25.03.2020

Bora Coşkun , Özgür Akkurt Buğra Çoşkun Tuğberk Güçlü Coşkun Şımşır

Abstract

ÖZET
Giriş: Gebeliğin intrahepatik kolestazı artmış gelişme geriliği, preeklampsi ve gestasyonel diyabet riski ile
karşı karşıyadır. Çalışmamızın amacı izole kolestaz saptanan kadınlar ile diğer hastalıkların eklendiği kolestazlı
kadınların perinatal sonuçlarını karşılaştırmaktır.
Gereç ve Yöntemler: tersiyer merkezde gerçekleştirilen retrospektif çalışmamızda 2 yıllık süreçte antenatal
kliniğine başvuran kolestaz tanılı kadınlar dahil edildi. Ek hastalık bulunanlar grup 1, izole kolestazlı kadınlar
grup 2 olarak değerlendirildi. Bu iki grup arasında maternal karakteristik özellikler, laboratuvar sonuçları ve
perinatal sonuçlar karşılaştırıldı.
Bulgular: Çalışma süresince gerçekleşen 25101 doğumun 117’sinde kolestaz saptandı (%0.46). Bunların
57’sinde (%48,8) hafif, 38’inde (%32,4) orta, 22’sinde (%18,8) şiddetli kolestaz tablosu izlenmiştir. Yine bu
kadınların, 79’unda (%59) GIHK izole olarak saptanmıştır ve kalan 38’inde (%32,4) ek morbidite; 10’unda
gestasyonel diyabet (%8,5), 11’unda preeklampsi (%13,6), 21’inde (%17,9) intrauterin gelişme geriliği. Kolestaz
saptanan gebelerde mekonyumla boyalı amniyon sıvısı ve prematür doğum oranı daha fazla, dolayısıyla
doğum haftası ve doğum ağırlığı daha erken ve düşük saptanmıştır. Takipte en yüksek karaciğer enzimleri
ve açlık safra asidi değerleri, düşük doğum haftası, mekonyumla boyalı amniyon sıvısı ve yenidoğan yoğun
bakıma yatış oranı komplike kolestazlı gebelerde izole kolestazlı gebelere oranla daha yüksek saptanmıştır.
Sonuç: Ek hastalığın eşlik ettiği kolestazlı kadınlarda perinatal mortalite ve morbidite daha yüksek izlenmiştir.
Bu nedenle komplike olmuş bu alt grubun daha yakın takibi ve erken gebelik sonlandırması uygun olabilir.
Anahtar Kelimeler: Gebelik; Kolestaz; Perinatal sonuçlar
ABSTRACT
Introduction: Intrahepatic cholestasis in pregnancy encounters the risks of increased development retardation,
preeclampsia and gestational diabetes. The aim of our study is to compare the perinatal outcomes in
women diagnosed with isolated cholestasis or with cholestasis complicated with accompanying diseases.
Material and Method: In our studies performed in a tertiary center, women applying to the antenatal clinic
and diagnosed with cholestasis within a period of 2 years. Women with additional diseases were included in
group 1, and those with isolated cholestasis were included in group 2. Maternal characteristics, laboratory
results and perinatal outcomes were compared between these two groups.
Findings: Cholestasis was found in 117 pregnant women in the 25101 births given within the study period
(0,46%). Of these, cholestasis was found mild in 57 (48,8%), medium level in 38 (32,4%) and serious in 22
(18,8%). ICP (intrahepatic cholestasis of pregnancy) was found as isolated in 79 of these women (59%), of
the remaining women, 38 had comorbidities (32,4%), 10 had gestational diabetes (8,5%), 11 had preeclampsia
(13,6%), and 21 had intrauterine growth retardation (17,9%). Meconium-stained amniotic fluid and
premature labor rate were higher in pregnant women with determined cholestasis, and therefore, birth
weeks and birth rate were lower. The rates of the highest liver enzymes and fasting bile acid values, lower
birth weeks, meconium-stained amniotic fluid and admission of the neonatal in the neonatal intensive care
unit were found higher in pregnant women with complicated cholestasis.
Conclusion: Perinatal mortality and morbidity were found higher in pregnant women with cholestasis
complicated with accompanying additional diseases. Therefore, closer follow-up and early termination of
pregnancy can be proper in this complicated subgroup.
Keywords: Cholestasis; Perinatal outcome; Pregnancy

Keywords

İZOLE VE KOMPLİKE KOLESTAZLI GEBE KADINLARIN PERİNATAL SONUÇLARININ KARŞILAŞTIRILMASI Comparison of Perinatal Outcomes in Pregnant Women with Isolated and Complicated Cholestasis

References

• 1- Lammert F, Marschall HU, Glantz A, Matern S. Intrahepatic cholestasis of pregnancy: molecular pathogenesis, diagnosis and management. J Hepatol. 2000; 33: 1012-21. 2- Turunen K, Helander K, Mattila KJ, Sumanen M. Intrahepatic cholestasis of pregnancy is common among patients' first-degree relatives. Acta Obstet Gynecol Scand. 2013; 92: 1108-10. 3- Biberoglu E, Kirbas A, Daglar K, Kara O, Karabulut E, Yakut HI, et al. Role of inflammation in intrahepatic cholestasis of pregnancy. J Obstet Gynaecol Res. 2016; 42: 252-7. 4- Larson SP, Kovilam O, Agrawal DK. Immunological basis in the pathogenesis of intrahepatic cholestasis of pregnancy. Expert Rev Clin Immunol. 2016; 1: 39-48. 5- Kohari KS, Carroll R, Capogna S, Ditchik A, Fox NS, Ferrara LA. Outcome after implementation of a modern management strategy for intrahepatic cholestasis of pregnancy. J Matern Fetal Neonatal Med. 2017; 30: 1342-1346. 6- Marathe JA, Lim WH, Metz MP, Scheil W, Dekker GA, Hague WM. A retrospective cohort review of intrahepatic cholestasis of pregnancy in a South Australian population. Eur J Obstet Gynecol Reprod Biol. 2017 Nov;218:33-38. 7- Wikström Shemer E, Marschall HU, Ludvigsson JF, Stephansson O. Intrahepatic cholestasis of pregnancy and associated adverse pregnancy and fetal outcomes: a 12-year population-based cohort study. BJOG. 2013 May;120(6):717-23. 8- Wikström Shemer EA, Stephansson O, Thuresson M, Thorsell M, Ludvigsson JF, Marschall HU. Intrahepatic cholestasis of pregnancy and cancer, immune-mediated and cardiovascular diseases: A population-based cohort study. J Hepatol. 2015; 63: 456-61. 9- American College of Obstetricians and Gynecologists; Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013; 122:1122-1131. 10- Kirbas A, Daglar K, Timur H, Biberoglu E, Inal HA, Kara O, et al. Maternal circulating levels of irisin in intrahepatic cholestasis of pregnancy. J Matern Fetal Neonatal Med. 2016; 29: 3483-7.