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İntrahepatik kolestazlı gebelerde maternal ve fetal sonuçların değerlendirilmesi

Year 2020, , 84 - 87, 15.06.2020
https://doi.org/10.16948/zktipb.714219

Abstract

Amaç:Bu çalışmada kliniğimizde gebeliğin intrahepatik kolestazı(GİK) tanısı konmuş gebelerin maternal ve fetal sonuçlarıdeğerlendirildi.
Yöntem ve gereçler:Bu çalışma retrospektif olarak tasarlanmış olup, Eylül 2017 ve Eylül 2018 tarihleri arasındaBursa Yüksek İhtisas Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum Kliniğine başvuran toplam 53 hastayla yapıldı.GİK tanısı kaşıntı ve karaciğer enzimleri ile açlık safra asit düzeylerinde artış(≥10 µmol/L) artış olması durumunda konuldu.Hastaların hastane kayıtlarından doğum bilgileri ve demografik özelliklerine ulaşıldı.
Bulgular:Çalışmaya alınan hastaların yaş ortalaması 30.5±5.7 yıl ve tanı anındaki gebelik yaşı ortalaması 32.3±2.8 hafta olarak saptandı. Ortalama safra asit düzeyi 26.42±19.1 µmol/Lolarak hesaplandı.Hastaların %26.4’ünde gestasyonel diyabet, %15.1’inde preeklampsi görüldü.Hastaların %37.7’sinin preterm doğum yaptığı tespit edildi.Yenidoğan bebeklerin %32.7’si yenidoğan yoğun bakım ünitesine alınırken, %32.7’sinde yenidoğan geçici taşipnesi, %33.3’ünde respiratuvar distres sendromu geliştiği görüldü.Perinatal mortalite ise saptanmadı.
Sonuç:Çalışma sonuçlarımıza göre, GİK takibinde en önemli unsurlar olan perinatal mortalite ve morbiditeyi azaltmak için hastaların yakın takibi ve şiddetli kolestaz bulguları olan hastaların belirlenip uygun tedavinin erken başlanması oldukça önemlidir.

References

  • Kaynaklar 1. Diken Z,Usta IM, Nassar AH. A clinical approach to intrahepatic cholestasis of pregnancy.Am J Perinatol2014;31:1–8.
  • 2. Estiu MC,Monte MJ, Rivas L, et al. Effect of ursodeoxycholic acid treatment on the altered progesterone and bile acid homeostasis in the mother-placenta foetus trio during cholestasis of pregnancy. Br J Clin Phramacol 2015;79:316–29.
  • 3. Brouwers L, Koster MP, Page-Christiaens GC, et al. Intrahepatic cholestasis of pregnancy: maternal and fetal outcomes associated with elevated bile acid levels. Am J Obstet Gynecol 2015; 212: 100. e1-7.
  • 4. Williamson C, Geenes V. Intrahepatic cholestasis of pregnancy. Obstet Gynecol 2014; 124: 120-133
  • 5.Parizek A, Hill M, Duskova M, Vitek L, Velikova M, Kancheva R. A comprehensive evaluation of steroid metabolism in women with intrahepatic cholestasis of pregnancy. PLoS One 2016;11:e0159203.
  • 6.Cui D, Zhong Y, Zhang L, et al. Bile acid levels and risk of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy: A meta-analysis. J Obstet Gynaecol Res. 2017; 43(9): 1411–1420
  • 7. Biberoglu E, Kirbas A, Daglar K, et al. Role of inflammation in intrahepatic cholestasis of pregnancy. J Obstet Gynaecol Res 2016; 42: 252-257.
  • 8. 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. Am J Obstet Gynecol 2015; 212: 667.e1-5.
  • 9. Wikström Shemer E, Marschall H, Ludvigsson J, Stephansson O. Intrahepatic cholestasis of pregnancy and associated adverse pregnancy and fetal outcomes: a 12-year population-based cohort study. BJOG 2013; 120: 717-723
  • 10. Martineau M, Raker C, Powrie R, et al. Intrahepatic cholestasis of pregnancy is associated with an increased risk of gestational diabetes. Eur J Obstet Gynecol Reprod Biol 2014; 176: 80-85.
  • 11. Raz Y, Lavie A, Vered Y, et al. Severe intrahepatic cholestasis of pregnancy is a risk factor for preeclampsia in singleton and twin pregnancies. Am J Obstet Gynecol 2015; 213: 395.e1-8
  • 12. Estiú MC, Frailuna MA, Otero C, et al. Relationship between early onset severe intrahepatic cholestasis of pregnancy and higher risk of meconium-stained fluid. PLoS One. 2017; 12(4): e0176504
  • 13.Mor M, Shmueli A, Krispin E.et al.Intrahepatic cholestasis of pregnancy as a risk factor for preeclampsia.Arch Gynecol Obstet 301,655–664 (2020).
  • 14.Shemer WE, Marschall HU, Ludvigsson JF, Stephansson O(2013) Intrahepatic cholestasis of pregnancy and associated adverse pregnancy and fetal outcomes: a 12-year population-based cohort study. BJOG 120(6):717–723
  • 15. Kawakita T, Parikh LI, Ramsey PS, et al. Predictors of adverse neonatal outcomes in intrahepatic cholestasis of pregnancy. Am J Obstet Gynecol. 2015; 213(4): 570.e1–570.e8
  • 16.Glantz A, Marschall HU, Mattsson LA. Intrahepatic cholestasis of pregnancy: Relationships between bile acid levels and fetal complication rates. Hepatology. 2004; 40(2): 467–474
  • 17. Campos GA, Castillo RJ, Toro FG. [Effect of bile acids on the myometral contractility of the isolated pregnant uterus]. Rev Chil Obstet Ginecol. 1988; 53(4): 229–233
  • 18. Germain AM, Kato S, Carvajal JA, et al. Bile acids increase response and expression of human myometrial oxytocin receptor. Am J Obstet Gynecol. 2003; 189(2): 577–582
  • 19.Arthuis C, Diguisto C, Lorphelin H , Dochez V ,Simon E,Perrotin F, Winer N.Perinatal outcomes of intrahepatic cholestasis during pregnancy: An 8-year case-control study.PLoS One 2020; 15(2): e0228213.
  • 20.Zecca E, De Luca D, Marras M, Caruso A, Bernardini T, Romagnoli C. Intrahepatic cholestasis of pregnancy and neonatal respiratory distress syndrome. Pediatrics. 2006; 117(5):1669–72
  • 21. Madazli R, Yuksel MA, Oncul M, et al. Pregnancy outcomes and prognostic factors in patients with intrahepatic cholestasis of pregnancy. J Obstet Gynaecol. 2015; 35(4): 358–361
  • 22. Oztas E, Erkenekli K, Ozler S, et al. Can routine laboratory parameters predict adverse pregnancy outcomes in intrahepatic cholestasis of pregnancy? J Perinat Med. 2015; 43(6): 667–674
  • 23.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. Hepatol Baltim Md. Avr 2014; 59(4):1482–91.
  • 24. Williamson C, Hems LM, Goulis DG, Walker I, Chambers J, Donaldson O, et al. Clinical outcome in a series of cases of obstetric cholestasis identified via a patient support group. BJOG Int J Obstet Gynaecol. juill 2004; 111(7):676–81.
  • 25. Williamson C, Gorelik J, Eaton BM, et al. The bile acid taurocholate impairs rat cardiomyocyte function: a proposed mechanism for intra-uterine fetal death in obstetric cholestasis. Clin Sci (Lond). 2001; 100(4): 363–369
  • 26.Ovadia C,SeedPT,Sklavounos A, Geenes V, Di Illio C, Chambers J, et al.Association of adverse perinataloutcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results ofaggregate and individual patient data meta-analyses.Lancet.2019;393(10174): 899–9092.
  • 27. Miragoli M, Kadir SH, Sheppard MN, et al. A protective antiarrhythmic role of ursodeoxycholic acid in an in vitro rat model of the cholestatic fetal heart. Hepatology. 2011; 54(4): 1282–1292
  • 28.ACOG Committee Opinion No. 764: Medically Indicated Late-Preterm and Early-Term Deliveries. Obstet Gynecol. 2019 Feb; 133(2):e151–e155
  • 29.Quigley MA, Poulsen G, Boyle E, Wolke D, Field D, Alfirevic Z, et al. Early term and late preterm birth are associated with poorer school performance at age 5 years: a cohort study. Arch Dis Child Fetal Neonatal Ed. mai 2012; 97(3):F167–173 30.Chappell LC, Gurung V, Seed PT, Chambers J, Williamson C, Thornton JG, et al. Ursodeoxycholic acid versus placebo, and early term delivery versus expectant management, in women with intrahepatic cholestasis of pregnancy: semifactorial randomised clinical trial. BMJ. 13 juin 2012; 344:e3799
Year 2020, , 84 - 87, 15.06.2020
https://doi.org/10.16948/zktipb.714219

Abstract

References

  • Kaynaklar 1. Diken Z,Usta IM, Nassar AH. A clinical approach to intrahepatic cholestasis of pregnancy.Am J Perinatol2014;31:1–8.
  • 2. Estiu MC,Monte MJ, Rivas L, et al. Effect of ursodeoxycholic acid treatment on the altered progesterone and bile acid homeostasis in the mother-placenta foetus trio during cholestasis of pregnancy. Br J Clin Phramacol 2015;79:316–29.
  • 3. Brouwers L, Koster MP, Page-Christiaens GC, et al. Intrahepatic cholestasis of pregnancy: maternal and fetal outcomes associated with elevated bile acid levels. Am J Obstet Gynecol 2015; 212: 100. e1-7.
  • 4. Williamson C, Geenes V. Intrahepatic cholestasis of pregnancy. Obstet Gynecol 2014; 124: 120-133
  • 5.Parizek A, Hill M, Duskova M, Vitek L, Velikova M, Kancheva R. A comprehensive evaluation of steroid metabolism in women with intrahepatic cholestasis of pregnancy. PLoS One 2016;11:e0159203.
  • 6.Cui D, Zhong Y, Zhang L, et al. Bile acid levels and risk of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy: A meta-analysis. J Obstet Gynaecol Res. 2017; 43(9): 1411–1420
  • 7. Biberoglu E, Kirbas A, Daglar K, et al. Role of inflammation in intrahepatic cholestasis of pregnancy. J Obstet Gynaecol Res 2016; 42: 252-257.
  • 8. 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. Am J Obstet Gynecol 2015; 212: 667.e1-5.
  • 9. Wikström Shemer E, Marschall H, Ludvigsson J, Stephansson O. Intrahepatic cholestasis of pregnancy and associated adverse pregnancy and fetal outcomes: a 12-year population-based cohort study. BJOG 2013; 120: 717-723
  • 10. Martineau M, Raker C, Powrie R, et al. Intrahepatic cholestasis of pregnancy is associated with an increased risk of gestational diabetes. Eur J Obstet Gynecol Reprod Biol 2014; 176: 80-85.
  • 11. Raz Y, Lavie A, Vered Y, et al. Severe intrahepatic cholestasis of pregnancy is a risk factor for preeclampsia in singleton and twin pregnancies. Am J Obstet Gynecol 2015; 213: 395.e1-8
  • 12. Estiú MC, Frailuna MA, Otero C, et al. Relationship between early onset severe intrahepatic cholestasis of pregnancy and higher risk of meconium-stained fluid. PLoS One. 2017; 12(4): e0176504
  • 13.Mor M, Shmueli A, Krispin E.et al.Intrahepatic cholestasis of pregnancy as a risk factor for preeclampsia.Arch Gynecol Obstet 301,655–664 (2020).
  • 14.Shemer WE, Marschall HU, Ludvigsson JF, Stephansson O(2013) Intrahepatic cholestasis of pregnancy and associated adverse pregnancy and fetal outcomes: a 12-year population-based cohort study. BJOG 120(6):717–723
  • 15. Kawakita T, Parikh LI, Ramsey PS, et al. Predictors of adverse neonatal outcomes in intrahepatic cholestasis of pregnancy. Am J Obstet Gynecol. 2015; 213(4): 570.e1–570.e8
  • 16.Glantz A, Marschall HU, Mattsson LA. Intrahepatic cholestasis of pregnancy: Relationships between bile acid levels and fetal complication rates. Hepatology. 2004; 40(2): 467–474
  • 17. Campos GA, Castillo RJ, Toro FG. [Effect of bile acids on the myometral contractility of the isolated pregnant uterus]. Rev Chil Obstet Ginecol. 1988; 53(4): 229–233
  • 18. Germain AM, Kato S, Carvajal JA, et al. Bile acids increase response and expression of human myometrial oxytocin receptor. Am J Obstet Gynecol. 2003; 189(2): 577–582
  • 19.Arthuis C, Diguisto C, Lorphelin H , Dochez V ,Simon E,Perrotin F, Winer N.Perinatal outcomes of intrahepatic cholestasis during pregnancy: An 8-year case-control study.PLoS One 2020; 15(2): e0228213.
  • 20.Zecca E, De Luca D, Marras M, Caruso A, Bernardini T, Romagnoli C. Intrahepatic cholestasis of pregnancy and neonatal respiratory distress syndrome. Pediatrics. 2006; 117(5):1669–72
  • 21. Madazli R, Yuksel MA, Oncul M, et al. Pregnancy outcomes and prognostic factors in patients with intrahepatic cholestasis of pregnancy. J Obstet Gynaecol. 2015; 35(4): 358–361
  • 22. Oztas E, Erkenekli K, Ozler S, et al. Can routine laboratory parameters predict adverse pregnancy outcomes in intrahepatic cholestasis of pregnancy? J Perinat Med. 2015; 43(6): 667–674
  • 23.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. Hepatol Baltim Md. Avr 2014; 59(4):1482–91.
  • 24. Williamson C, Hems LM, Goulis DG, Walker I, Chambers J, Donaldson O, et al. Clinical outcome in a series of cases of obstetric cholestasis identified via a patient support group. BJOG Int J Obstet Gynaecol. juill 2004; 111(7):676–81.
  • 25. Williamson C, Gorelik J, Eaton BM, et al. The bile acid taurocholate impairs rat cardiomyocyte function: a proposed mechanism for intra-uterine fetal death in obstetric cholestasis. Clin Sci (Lond). 2001; 100(4): 363–369
  • 26.Ovadia C,SeedPT,Sklavounos A, Geenes V, Di Illio C, Chambers J, et al.Association of adverse perinataloutcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results ofaggregate and individual patient data meta-analyses.Lancet.2019;393(10174): 899–9092.
  • 27. Miragoli M, Kadir SH, Sheppard MN, et al. A protective antiarrhythmic role of ursodeoxycholic acid in an in vitro rat model of the cholestatic fetal heart. Hepatology. 2011; 54(4): 1282–1292
  • 28.ACOG Committee Opinion No. 764: Medically Indicated Late-Preterm and Early-Term Deliveries. Obstet Gynecol. 2019 Feb; 133(2):e151–e155
  • 29.Quigley MA, Poulsen G, Boyle E, Wolke D, Field D, Alfirevic Z, et al. Early term and late preterm birth are associated with poorer school performance at age 5 years: a cohort study. Arch Dis Child Fetal Neonatal Ed. mai 2012; 97(3):F167–173 30.Chappell LC, Gurung V, Seed PT, Chambers J, Williamson C, Thornton JG, et al. Ursodeoxycholic acid versus placebo, and early term delivery versus expectant management, in women with intrahepatic cholestasis of pregnancy: semifactorial randomised clinical trial. BMJ. 13 juin 2012; 344:e3799
There are 29 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Original Research
Authors

Gültekin Adanas

Gülten Özgen 0000-0002-7888-7583

Publication Date June 15, 2020
Published in Issue Year 2020

Cite

APA Adanas, G., & Özgen, G. (2020). İntrahepatik kolestazlı gebelerde maternal ve fetal sonuçların değerlendirilmesi. Zeynep Kamil Tıp Bülteni, 51(2), 84-87. https://doi.org/10.16948/zktipb.714219
AMA Adanas G, Özgen G. İntrahepatik kolestazlı gebelerde maternal ve fetal sonuçların değerlendirilmesi. Zeynep Kamil Tıp Bülteni. June 2020;51(2):84-87. doi:10.16948/zktipb.714219
Chicago Adanas, Gültekin, and Gülten Özgen. “İntrahepatik Kolestazlı Gebelerde Maternal Ve Fetal sonuçların değerlendirilmesi”. Zeynep Kamil Tıp Bülteni 51, no. 2 (June 2020): 84-87. https://doi.org/10.16948/zktipb.714219.
EndNote Adanas G, Özgen G (June 1, 2020) İntrahepatik kolestazlı gebelerde maternal ve fetal sonuçların değerlendirilmesi. Zeynep Kamil Tıp Bülteni 51 2 84–87.
IEEE G. Adanas and G. Özgen, “İntrahepatik kolestazlı gebelerde maternal ve fetal sonuçların değerlendirilmesi”, Zeynep Kamil Tıp Bülteni, vol. 51, no. 2, pp. 84–87, 2020, doi: 10.16948/zktipb.714219.
ISNAD Adanas, Gültekin - Özgen, Gülten. “İntrahepatik Kolestazlı Gebelerde Maternal Ve Fetal sonuçların değerlendirilmesi”. Zeynep Kamil Tıp Bülteni 51/2 (June 2020), 84-87. https://doi.org/10.16948/zktipb.714219.
JAMA Adanas G, Özgen G. İntrahepatik kolestazlı gebelerde maternal ve fetal sonuçların değerlendirilmesi. Zeynep Kamil Tıp Bülteni. 2020;51:84–87.
MLA Adanas, Gültekin and Gülten Özgen. “İntrahepatik Kolestazlı Gebelerde Maternal Ve Fetal sonuçların değerlendirilmesi”. Zeynep Kamil Tıp Bülteni, vol. 51, no. 2, 2020, pp. 84-87, doi:10.16948/zktipb.714219.
Vancouver Adanas G, Özgen G. İntrahepatik kolestazlı gebelerde maternal ve fetal sonuçların değerlendirilmesi. Zeynep Kamil Tıp Bülteni. 2020;51(2):84-7.