Intrahepatic Cholestasis Of Pregnancy And Its Management

Abstract

Intrahepatic cholestasis of pregnancy ICP is the most frequent liver disease in pregnancy and is specific to pregnancy period. Genetic, hormonal, environmental factors have been accused in its pathogenesis. Pruritus is the first and the most frequent symptom of the disease. Progressive increase in serum transaminase and bile acid levels are frequent laboratorial findings. The maternal complications of ICP are rare, but include gallstones, cholecystitis, pancreatitis and liver cirrhosis. ICP also increases the risk of fetal and neonatal complications, such as perinatal mortality, stillbirth, low birth weight, fetal distress in labor and meconium aspiration, preterm labor and birth, fetal and neonatal arrhythmia. ICP may recur in subsequent pregnancies for more than 50 per cent. Ursodeoxycholic acid is the most effective therapeutic option to provide the best symptomatic and laboratorial results, but there’s not enough data to assure satisfying neonatal outcomes. Generally, induction of labor in the 37th weeks of gestation was showed to lower perinatal mortality in many studies. Studies to find out the genetic basis of the disease comprehensively are still carried on. In the future, it’s expected that partially or complete alleviation of the disease may be provided at the hands of decryption and treatment of situations which cause genetic proneness, while it’s considered as a highly repetitive disease.

Keywords

• Obstetric cholestasis,pathogenesis,management,timing for delivery

Gebeliğin İntrahepatik Kolestazı ve Yönetimi

Abstract

Gebeliğin intrahepatik kolestazı, gebeliğe özgü olup, gebelikte en sık rastlanan karaciğer hastalığıdır. Patogenezinde genetik, hormonsal ve çevresel faktörler suçlanmıştır. Kaşıntı, ilk ve en sık gözlenen şikayettir. Karaciğer fonksiyonlarını gösteren serum transaminaz ve safra asitleri düzeylerinin ilerleyici artışı sık görülen laboratuvar bulgularıdır. Hastalığın maternal komplikasyonları safra taşları, kolesistit, pankreatit ve siroz gibi hastalıklar olup, nadir gelişir. Fetal ve neonatal açıdan da prematürite, düşük doğum ağırlığı, perinatal ölüm, mekonyum aspirasyon sendromu, eylemde fetal distres, fetal ve neonatal aritmi görülebilmektedir. Sonraki gebeliklerde %50 üzeri bir oranda tekrarlama olasılığı vadır. Tedavide en etkili semptomatik ve laboratuvar iyileşmesini sağlayan ilaç ursodeoksikolik asit olup, neonatal sonuçları iyileştirdiğine dair yeterli kanıt yoktur. Genelde, 37 gebelik haftasında indüklenen doğumun perinatal ölümü azalttığına dair çok sayıda veri vardır. Hastalığın genetik temellerine dair çalışmalar halen sürmektedir. Hastalığın büyük ölçüde tekrarlayıcı olabildiği düşünüldüğünde, gelecekte, genetik yatkınlık yaratan durumların tespit ve tedavisiyle, , daha hafif geçirilmesi veya tam iyileşme sağlanabilmesi beklenmektedir.

Keywords

• Gebelik kolestazı,patogenez,yönetim,doğum zamanlaması

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