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

Öz

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

Anahtar Kelimeler

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

Kaynakça

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