Gebeliğin intrahepatik kolestazında hastalığın şiddeti ve tedaviye yanıtın perinatal sonuçlara etkisi

Yıl 2023, , 1797 - 1803, 01.10.2023

Ebru Okudan , Münip Akalın , Oya Demirci

https://doi.org/10.38136/jgon.1140832

Öz

Amaç: Gebeliğin intrahepatik kolestazı (GİHK) ile komplike olan gebeliklerde, serum safra asiti (SA) düzeyleri ve ursodeoksikolik asit (UDKA) tedavisine verilen cevabın perinatal sonuçlar üzerine etkisini araştırmaktır.
Gereçler ve Yöntem: Bu çalışmada Ocak 2013 ile Ocak 2018 tarihleri arasında üçüncü basamak bir merkezde GİHK nedeniyle takip edilen gebelikler retrospektif olarak analiz edildi. GİHK şiddeti, serum SA seviyelerine göre hafif (10–40 μmol/L), orta (40-80 μ mol/L) ve şiddetli (>80 μ mol/L) olarak gruplandırıldı. GİHK’nın şiddeti ve UDKA tedavisine verilen olumlu veya olumsuz yanıtın perinatal sonuçlar üzerine etkisi araştırıldı.
Bulgular: GİHK tanısı koyulan toplamda 200 gebe çalışmaya dahil edildi. Hastaların %65 (n=130)’inde hafif GİHK, %20 (n=40)’sinde orta şiddetli GİHK ve %15 (n=30)’inde şiddetli GİHK saptandı. GİHK tanısıyla takip edilen hastaların 4 (%2.0)’ünde ölü doğum gerçekleşti. Şiddetli GİHK hastalarında spontan preterm doğum oranı, orta ve hafif GİHK hastalarına kıyasla anlamlı olarak daha yüksekti (p=0.001). Şiddetli GİHK hastalarında ve UDKA tedavisine yanıt vermeyen hastalarda, ortalama doğum haftası, ortalama doğum ağırlığı, 1. ve 5. dakika Apgar skorları daha düşük, amniyosta mekonyum varlığı, yenidoğan yoğun bakım ünitesi ihtiyacı ve ölü doğum oranları daha yüksekti.
Sonuç: GİHK ile komplike olan gebelikler fetal ve neonatal olumsuz sonuçlar açısından artmış riske sahiptir. Maternal serum SA düzeyleri hastalığın siddeti ve olumsuz perinatal sonuçlarla ilişkilidir. Bununla birlikte, UDKA tedavisine verilen klinik cevap, fetal ve neonatal sonuçları öngörmede etkili olabilir.

Anahtar Kelimeler

Gebeliğin intrahepatik kolestazı, gebelik kolestazı, kolestaz, yenidoğan sonuçları, ursodeoksikolik asit.

Teşekkür

Verilerin analizinde yardımcı olan Dr. Merve Evrensel’e teşekkür ederiz.

The effect of disease severity and response to treatment on perinatal outcomes in intrahepatic cholestasis of pregnancy

Öz

Aim: To investigate the effects of serum bile acid (BA) levels and response to ursodeoxycholic acid (UDCA) treatment on perinatal outcomes in pregnancies complicated by intrahepatic cholestasis of pregnancy (ICP).
Materials and Method: In this retrospective study, pregnancies followed for GIHC at a tertiary center between January 2013 and January 2018 were analyzed. ICP severity was classified according to serum BA levels as mild (10–40 μmol/L), moderate (40-80 μ mol/L) and severe (>80 μ mol/L). The effects of the severity of ICP and the positive or negative response to UDCA treatment on perinatal outcomes were investigated.
Results: A total of 200 pregnant women diagnosed with ICP were included in the study. Mild ICP was detected in 65% (n=130) of the patients, moderate ICP in 20% (n=40) and severe ICP in 15% (n=30). Stillbirth occurred in 4 (2.0%) of the patients. Spontaneous preterm birth rate was significantly higher in patients with severe ICP compared with patients with moderate and mild ICP (p=0.001). Mean gestational age, mean birth weight, 1st and 5th minute Apgar scores were lower, and the presence of meconium in the amniotic fluid, need for neonatal intensive care unit and stillbirth rates were higher in patients with severe ICP and patients who did not respond to UDCA treatment.
Conclusion: Pregnancies complicated by ICP have an increased risk for adverse fetal and neonatal outcomes. Maternal serum BA levels are associated with disease severity and adverse perinatal outcomes. The clinical response to UDCA treatment may be effective in predicting fetal and neonatal outcomes.

Anahtar Kelimeler

Cholestasis, cholestasis of pregnancy, intrahepatic cholestasis of pregnancy, neonatal outcomes, ursodeoxycholic acid.

Kaynakça

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