The effect of intrahepatic cholestasis of pregnancy on maternal and perinatal outcomes

Year 2015, , 100 - 105, 16.03.2015

Mehmet Bayrak , Taner Günay , Cihan Karadağ , Zelal Balçık

https://doi.org/10.16948/zktb.37157

Abstract

Objective: To evaluate maternal and perinatal outcomes of the pregnancies complicated by intrahepatic cholestasis of pregnancy and to discuss the appropriate pregnancy management

Material and Method: Maternal and fetal characteristics were analyzed from the medical records of 32 patients who gave birth following a pregnancy complicated with intrahepatic cholestasis of pregnancy between January 2009 and December 2013.

Results: A total of 32 patients with intrahepatic cholestasis of pregnancy were enrolled the study. Diagnosis of intrahepatic cholestasis was made at an average of 34.15±3.1 gestational weeks and mean gestational time at birth was found to be 37.4±1.86 gestational weeks.  Preterm birth rate (<37 gestational weeks) was 20.59%. Mean birth weight and  a low (<7) 5- minute APGAR score were 2980±480g., and 14.70%, respectively. Meconium was detected in amniotic fluid in 14.70 % of the cases and admission rate to neonatal care unit was 12.50 %. There were no reported cases of stillbirth. The incidence of gestational diabetes mellitus in intrahepatic cholestasis of pregnancy was 15.62%.

Conclusion: Our data confirm an increased risk of preterm delivery in intrahepatic cholestasis of pregnancy. The high rates of  gestational diabetes mellitusis need to be considered in the management of intrahepatic cholestasis of pregnancy.

Keywords

Intrahepatik cholestasis of pregnancy, maternal and perinatal outcomes, gestational diabetes mellitus

Gebeliğin intrahepatik kolestazının maternal ve perinatal sonuçlara etkisinin değerlendirilmesi

Abstract

Amaç: Gebeliğin intrahepatik kolestazı tanısıyla takip edilen hastaların maternal ve perinatal sonuçlarının değerlendirilmesi ve uygun gebelik yönetiminin tartışılması amaçlandı.

Gereç ve Yöntem: Ocak 2009 ve Aralık 2013 yılları arasında gebeliğin intrahepatik kolestazı tanısı alan 32 hastanın dosyalarına retrospektif olarak ulaşılarak maternal ve perinatal sonuçlar açısından analiz edildi.

Bulgular: Toplam 32 hasta çalışmaya dahil edildi. Gebeliğin intrahepatik kolestazı ortalama tanı haftası 34,15±3,1 ve ortalama doğum haftası 37,4±1,86 hafta olarak bulundu. Preterm doğum oranı (doğumda gebelik haftası<37) %20,59 (7/34 yenidoğan) olarak saptandı. Ortalama doğum ağırlığı 2980±480 gram idi. Yenidoğanların %14,7’nin doğumda 5. dakika APGAR skorunun 7’nin altında olduğu izlendi. Yenidoğanların %14,7’sinde amnion mayisinde mekonyum pasajı izlendi. Dört (%12,5) yenidoğanın yoğun bakım ünitesine gönderilme gereksinimi oldu. Perinatal mortalite saptanmadı. Gebeliğin intrahepatik kolestazı tanılı hastalarda gestasyonel diyabetes mellitus insidansının %15,6 olduğu izlendi.

Sonuç: Çalışmamız gebeliğin intrahepatik kolestazı tanılı gebelerde preterm doğum riskinin arttığını doğrulamaktadır. Gebeliğin intrahepatik kolestazı tanılı hastalarda gestasyonel diyabetes mellitus riskinin artmış olması da hastalığın yönetiminde dikkate alınması gereken bir durum olduğunu düşünmekteyiz.

Keywords

Gebeliğin intrahepatik kolestazı, maternal ve perinatal sonuçlar, gestasyonel diyabetes mellitus

References

• 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;120:717-23.
• Royal College of Obstetricians and Gynecologists. Obstetric cholestasis: Green-top Guideline no. 43. London:RCOG; 2011
• Geenes V, Williamson C. Intrahepatic cholestasis of pregnancy. World J Gastroenterol 2009;15:2049–66.
• Henderson CE, Shah RR, Gottimukkala S, Ferreira KK, Hamaoui A, Mercado R. Primum non nocere: how active management became modus operandi for intrahepatic cholestasis of pregnancy. Am J Obstet Gynecol. 2014 Article in press doi: 10.1016/j.ajog.2014.03.058
• American College of Obstetricians and Gynecologists. Medically indicated late preterm and early term deliveries. Committee Opinion no. 560. Obstet Gynecol 2013;121:908-10
• Rook M, Vargas J, Caughey A, Bacchetti P, Rosenthal P, Bull L. Fetal outcomes in pregnancies complicated by intrahepatic cholestasis of pregnancy in a Northern California cohort. PLoS One. 2012;7(3):e28343. doi: 10.1371/journal.pone.0028343
• Yılmaz S, Üstün Y,Hızlı D, Deveer R. Gebeliğin İntrahepatik Kolestazı. Gazi Med J 2012; 23: 138-44
• Wagner M, Trauner M. Transcriptional regulation of hepatobiliary transport systems in health and disease: implications for a rationale approach to the treatment of intrahepatic cholestasis. Ann Hepatol 2005; 4: 77-99.
• Reyes H, Simon FR. Intrahepatic cholestasis of pregnancy: an estrogen related disease. Semin Liver Dis 1993; 13: 289-301.
• Geier A, Wagner M, Dietrich CG, Trauner M. Principles of hepatic organic anion transporter regulation during cholestasis, inflammation and liver regeneration. Biochim Biophys Acta 2007; 1773: 283-308.
• Reyes H, Sjovall J. Bile acids and progesterone metabolites in intrahepatic cholestasis of pregnancy. Ann Med 2000; 32: 94-106.
• Yıldırım G, Aslan H, Gedikbaşı A, et al. İntrahepatik kolestazda gebelik sonuçları. Türk Jinekoloji ve Obstetrik Derneği Dergisi 2007; 4: 250-253.
• Altınbaş ŞK, Karçaaltıncaba D, Kandemir Ö, Yalvaç S. İntrahepatik gebelik kolestazı: 33 vakanın maternal ve fetal sonuçlarının değerlendirilmesi. Bakırköy Tıp Dergisi 2013;4:171-175.
• Kenyon, A. P., Piercy, C. N., Girling, J., Williamson, C., Tribe, R. M., & Shennan, A. H. Pruritus may precede abnormal liver function tests in pregnant women with obstetric cholestasis: a longitudinal analysis. BJOG: An International Journal of Obstetrics & Gynaecology, 2001, 108.11: 1190-1192.
• Davidson KM. Intrahepatic cholestasis of preganancy. Seminars in Perinatology 1998; 22: 104- 11.
• Brites D, Rodrigues CM, van Zeller H, Brito A, Silva R. Relevance of serum bile acid profile in the diagnosis of intrahepatic cholestasis of pregnancy in an high incidence area: Portugal. Eur J Obstet Gynecol Reprod Biol 1998; 80: 31-38.
• Pata O, Vardarel› E, Ozcan A, Serteser M, Unsal I, Saruç M, et al. Intrahepatic cholestasis of pregnancy: correlation of preterm delivery with bile acids. Turk J Gastroenterol 2011; 22:602-5.
• Geenes V, Chappell LC, Seed PT, Steer PJ, Knight M, Williamson C. Association of severe intrahepatic cholestasis of pregnancy with adverse pregnancy outcomes: a prospective population-based case-control study. Hepatology2013;26617. http://dx.doi.org/10.1002/hep.26617
• Mazella G, Nicola R, Franceso A, Patrizia S, Luciano B, Anna M, et al. Ursodeoxycholic acid administration in patients with cholestasis of pregnancy; effects on primary bile acids in babies and mothers. Hepatology 2001; 33: 504- 8.
• Geenes V, Lövgren-Sandblom A, Benthin L, Lawrance D, Chambers J, et al. (2014) The Reversed Feto-Maternal Bile Acid Gradient in Intrahepatic Cholestasis of Pregnancy Is Corrected by Ursodeoxycholic Acid. PLoS ONE 9(1): e83828. doi:10.1371/journal.pone.0083828
• Glantz A, Marschall HU, Lammert F, Mattsson LA. Intrahepatic of pregnancy: a randomized control trial comparing dexamethasone and ursodeoxycholic acid. Hepatology 2005; 42(6): 1399–1405
• Chappell LC, Gurung V, Seed PT, Chambers J, Williamson C, Thornton JG; PITCH Study Consortium. Ursodeoxycholic acid versus placebo, and early term delivery versus expectant management, in women with intrahepatic cholestasis of pregnancy: semifactorial randomised clinical trial. BMJ. 2012 Jun 13;344:e3799. doi: 10.1136/bmj.e3799
• Henderson CE, Shah RR, Gottimukkala S, Ferreira KK, Hamaoui A, Mercado R. Primum non nocere: how active management became modus operandi for intrahepatic cholestasis of pregnancy. Am J Obstet Gynecol. 2014 Apr 1. pii: S0002-9378(14)00327-5. doi: 10.1016/j.ajog.2014.03.058
• Martineau M, Raker C, Powrie R, Williamson C. Intrahepatic cholestasis of pregnancy is associated with an increased risk of gestational diabetes. Eur J Obstet Gynecol Reprod Biol. 2014 May;176:80-5. doi: 10.1016/j.ejogrb.2013.12.037