Gebelik intrahepatik kolestazının şiddeti, prostaglandin E2 ile indüklenen multipar kadınlarda doğumun ilk aşamasını kısaltabilir

Yıl 2020, , 251 - 257, 01.06.2020

Banuhan Şahin , Samettin Çelik , Canan Soyer , Şafak Hatırnaz , Handan Çelik

https://doi.org/10.21601/ortadogutipdergisi.737898

Öz

Amaç: Vajinal prostaglandin E2 (PGE2) ile indüklenen multipar kadınlarda gebeliğin intrahepatik kolestazına (ICP) bağlı artan serum safra asit konsantrasyonları ile doğumun ilk evresi arasındaki ilişkiyi belirlemek.
Gereç ve Yöntemler: Bu retrospektif vaka-kontrol çalışmasında 283 ICP’li ve 283 sağlıklı multipar gebe doğum indüksiyonu için kabul edildi, vajinal olarak PGE2 (10 mg dinoproston) yerleştirildi. Hafif, orta ve şiddetli ICP’li gruplar, PGE2’nin vajinal yerleştirilmesinin başlangıcından doğumun aktif evresine kadar geçen süreler, PGE2’nin vajinal yerleştirilmesinin başlangıcından serviksin tamamen dilatasyonuna kadar geçen süreler ve fetal sonuçlar açısından kontrol grubu ile karşılaştırıldı.
Bulgular: Hafif, orta ve şiddetli ICP gruplarında PGE2’nin yerleştirilmesinin başlangıcından aktif evreye kadar geçen süre ICP olmayan gruptakine göre daha kısaydı; sırasıyla, 3,19±0,32, 7,26±0,34, 8,71±0,35 saat (p <0,01). Hafif, orta ve şiddetli ICP gruplarında PGE2’nin yerleştirilmesinin başlangıcından serviksin tamamen dilatasyonuna kadar geçen süre ICP olmayan gruptakine göre daha kısaydı; sırasıyla, 3,03±0,45, 10,33±0,62, 14,44±0,53 saat (p <0,01). Gruplar arasında fetal ağırlık ve mekonyum varlığı dışında fetal sonuçlar açısından fark yoktu (p <0,01).
Sonuç: Hafif, orta ve şiddetli ICP’de vajinal PGE2 ile indüklenen multipar gebe kadınlarda artan safra asidi konsantrasyonları, daha kısa servikal olgunlaşma süresi ve daha kısa doğum indüksiyon süresi ile ilişkilidir. Bu çalışma, ICP’li multipar gebelerin kolestazın şiddeti arttıkça daha hızlı doğum yapabilecekleri sonucuna vardı.

Anahtar Kelimeler

doğum süresi, gebeliğin intrahepatik kolestazı, kolestazın şiddeti, prostaglandin E2, safra asidi

The severity of intrahepatic cholestasis of pregnancy can shorten the first stage of labor in multiparous women induced by prostaglandin E2

Öz

Aim: To determine the relationship between increased serum bile acid concentrations and the first stage of labor in multiparous women induced by vaginal prostaglandin E2 (PGE2) with intrahepatic cholestasis of pregnancy (ICP).
Material and Methods: In this retrospective case-control study 283 multiparous women with ICP and 283 healthy multiparous pregnant women were admitted for induction of delivery, were inserted PGE2 (10 mg dinoprostone) vaginally. The groups with mild, moderate and severe ICP were compared with control group in terms of the time from beginning of PGE2 vaginal insertion to active phase of labor, the time from beginning of PGE2 vaginal insertion to complete dilatation of cervix and fetal outcomes.
Results: The time from beginning of PGE2 insertion to active phase in the mild, moderate and severe ICP groups were shorter than in the non-ICP group; 3.19±0.32, 7.26±0.34, 8.71±0.35 hours, respectively (p<0.01). The time from beginning of PGE2 insertion to complete dilatation of cervix in the groups with mild, moderate and severe ICP were shorter than in non-ICP group; 3.03 ± 0.45; 10.33 ± 0.62; 14.44 ± 0.53, respectively (p<0.01). There was no difference between the groups in terms of fetal outcomes except fetal weight and the presence of meconium (p<0.01).
Conclusion: Increased bile acid concentrations in multiparous pregnant women induced by vaginal PGE2 with mild, moderate and severe ICP are associated with shorter duration of cervical ripening and labor induction time to delivery. The study concluded that multiparous women with ICP can deliver faster as the severity of cholestasis increases.

Anahtar Kelimeler

bile acid, duration of labor, intrahepatic cholestasis of pregnancy, prostaglandin E2, severity of cholestasis

Kaynakça

• Williamson C, Geenes V. Intrahepatic cholestasis of pregnancy. Obstetrics and Gynecology 2014; 124: 120-33. (doi: 10.1097/AOG.0000000000000346).
• Bicocca MJ, Sperling JD, Chauhan SP. Intrahepatic cholestasis of pregnancy: Review of six national and regional guidelines. European Journal of Obstetrics and Gynecology and Reproductive Biology 2018; 231: 180-7. (doi: 10.1016/j.ejogrb.2018.10.041).
• Than NN, Neuberger J. Liver abnormalities in pregnancy. Best Practice and Research: Clinical Gastroenterology 2013; 27: 565-75. (doi: 10.1016/j.bpg.2013.06.015).
• Brouwers L, Koster MP, Page-Christiaens GC, et al. Intrahepatic cholestasis of pregnancy: maternal and fetal outcomes associated with elevated bile acid levels. American Journal of Obstetrics and Gynecology 2015; 212: 1-7. (doi: 10.1016/j.ajog.2014.07.026).
• Bacak SJ, Olson-Chen C, Pressman E. Timing of induction of labor. Seminars in Perinatology 2015; 39: 450-8. (doi: 10.1053/j.semperi.2015.07.007).
• Geenes V, Chappell LC, Seed PT, et al. Association of severe intrahepatic cholestasis of pregnancy with adverse pregnancy outcomes: a prospective population-based case-control study. Hepatology 2014; 59: 1482-91. (doi: 10.1002/hep.26617).
• Diken Z, Usta IM, Nassar AH. A clinical approach to intrahepatic cholestasis of pregnancy. American Journal of Perinatology 2014; 31: 1-8. (doi: 10.1055/s-0033-1333673).
• Glantz A, Marschall HU, Mattsson LA. Intrahepatic cholestasis of pregnancy: Relationships between bile acid levels and fetal complication rates. Hepatology 2004; 40: 467-74. (doi: 10.1002/hep.20336).
• Tran TT, Ahn J, Reau NS. ACG clinical guideline: liver disease and pregnancy. The American Journal of Gastroenterology 2016; 111: 176-94. (doi: 10.1038/ajg.2016.462).
• Lo JO, Shaffer BL, Allen AJ, et al. Intrahepatic cholestasis of pregnancy and timing of delivery. Journal of Maternal-Fetal and Neonatal Medicine 2015; 28: 2254-8. (doi: 10.3109/14767058.2014.984605).
• Marathe JA, Lim WH, Metz MP, et al. A retrospective cohort review of intrahepatic cholestasis of pregnancy in a South Australian population. European Journal of Obstetrics and Gynecology and Reproductive Biology 2017; 218: 33-8. (doi: 10.1016/j.ejogrb.2017.09.012).
• Germain AM, Kato S, Carvajal JA, et al. Bile acids increase response and expression of human myometrial oxytocin receptor. American Journal of Obstetrics and Gynecology 2003; 189: 577-82. (doi: 10.1067/S0002-9378(03)00545-3).
• Sharifzadehgan S, Hermann M, Nedellec S, et al. Intrahepatic cholestasis of pregnancy: Shorter duration of labor? European Journal of Obstetrics and Gynecology and Reproductive Biology 2018; 225: 258-9. (doi: 10.1016/j.ejogrb.2018.03.045).
• 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: e0176504. (doi: 10.1371/journal.pone.0176504).
• Chappell LC, Gurung V, Seed PT, et al. 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. British Medical Journal 2012; 344: 3799. (doi: 10.1136/bmj.e3799).
• Zhang J, Troendle J, Mikolajczyk R, et al. The natural history of the normal first stage of labor. Obstet Gynecol 2010; 115: 705. (doi: 10.1097/AOG.0b013e3181d55925).
• Wikstron Shemer E, Marschall HU, Ludvigsson J, et al. Intrahepatic cholestasis of pregnancy and associated adverse pregnancy and fetal outcomes: a 12- year population-based cohort study. BJOG 2013; 120: 717-23. (doi: 10.1111/1471-0528.12174).
• 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. American Journal of Obstetrics and Gynecology 2015; 212: 667: 1-5. (doi: 10.1016/j.ajog.2015.02.012).
• Zhao P, Zhang K, Yao Q, et al. Uterine contractility in intrahepatic cholestasis of pregnancy. Journal of Obstetrics and Gynaecology 2014; 34: 221-4. (doi: 10.3109/01443615.2013.834878).
• Friberg AK, Zingmark V, Lyndrup J. Early induction of labor in high-risk intrahepatic cholestasis of pregnancy: what are the costs? Archives of Gynecology and Obstetrics 2016; 294: 709-14. (doi: 10.1007/s00404-016-4019-8).
• Webster JR, Chappell L, Cheng F, et al. Operative delivery rates following induction of labour for obstetric cholestasis. Obstetric Medicine 2011; 4: 66-9. (doi: 10.1258/om.2011.110080).
• Wikström Shemer EA, Thorsell M, Marschall HU, et al. Risks of emergency cesarean section and fetal asphyxia after induction of labor in intrahepatic cholestasis of pregnancy: a hospital-based retrospective cohort study. Sexual and Reproductive HealthCare 2013; 4: 17-22. (doi: 10.1016/j.srhc.2012.11.005).
• 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. Journal of Obstetrics and Gynaecology Research 2017; 43: 1411-20. (doi: 10.1111/jog.13399).
• Kawakita T, Parikh LI, Ramsey PS, et al. Predictors of adverse neonatal outcomes in intrahepatic cholestasis of pregnancy. American Journal of Obstetrics and Gynecology 2015; 213: 5701-8. (doi: 10.1016/j.ajog.2015.06.021).
• Arthur C, Mahomed K. Intrahepatic cholestasis of pregnancy: diagnosis and management; a survey of Royal Australian and New Zealand College of Obstetrics and Gynaecology fellows. Australian and New Zealand Journal of Obstetrics and Gynaecology 2014; 54: 263-7. (doi: 10.1111/ajo.12178).