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Federación Mexicana de Ginecología y Obstetricia, A.C.

2015, Number 12

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Ginecol Obstet Mex 2015; 83 (12)

Perinatal outcomes in patients with cholestasis of pregnancy

Carballo-Núñez E, González-Rodríguez L, González-Boubeta R, Alves-Pérez MT

Language: Spanish
References: 29
Page: 776-784
PDF size: 348.76 Kb.


ABSTRACT

Background: Obstetric cholestasis has been associated with an increased risk of preterm delivery, intrapartum meconium, foetal distress and intrauterine foetal death. There is no consensus about the frequency of each of these complications or about the prognostic value of serum bile acids and transaminase levels. Bile acids levels above 40μml/L have been associated with adverse perinatal outcomes.
Objectives: To determine the frequency of adverse perinatal outcomes in single pregnancies with cholestasis of pregnancy and assess the association between levels of bile acids and transaminases in maternal serum, together with perinatal outcomes.
Material and method: Retrospective descriptive study of 71 women diagnosed of intrahepatic cholestasis in the years 2006-2011 in the University of Vigo Clinical Hospital Complex (Spain).
Results: The mean gestational age at the diagnostic was 35 weeks 6 days, being 10% of babies premature. There was one intrauterine foetal death (1.4%). We found 18.3% intrapartum meconium. Caesarean sections were performed in 5.6% of the deliveries due to foetal distress. No neonate presented Apgar ‹ 7, or PH in the umbilical artery ‹ 7. The 75,5% of infants did not present respiratory distress, while 5 (6.75%) presented serious distress. We found no statistically significant association between adverse perinatal outcomes and the level of bile acids. High levels of transaminases were related to prematurity (p = 0.009; p = 0.010) and severe distress (p = 0.027; p = 0.008).
Conclusion: The low frequency of adverse outcomes observed in our series could be in relation to the low rate of prematurity. Neither the biochemical nor clinical features are suitable for predicting foetal complications.


REFERENCES

  1. Geenes V, Williamson C. Intrahepatic cholestasis of pregnancy. World J. Gastroenterol 2009 may 7;15(17):2049-66.

  2. Kondrackiene J, Kupcinskas L. Intrahepatic cholestasis of pregnancy-current achievements and unsolved problems. World J Gastroenterol 2008 oct 14;14(38):5781-8.

  3. Glantz A, Marschall HU, Mattsson LA. Intrahepatic cholestasis of pregnancy: Relationships between bile acid levels and fetal complication rates. Hepatology 2004 ago;40(2):467-74.

  4. Kenyon AP, Piercy CN, Girling J, Williamson C, Tribe RM, Shennan AH. Obstetric cholestasis, outcome with active management: a series of 70 cases. BJOG 2002 mar;109(3):282-8.

  5. Royal College of Obstetricians and Gynaecologists. Obstetric cholestasis (Greentop guideline 43). RCOG 2011.

  6. Paternoster DM, Fabris F, Palù G, Santarossa C, Bracciante R, Snijders D, et al. Intra-hepatic cholestasis of pregnancy in hepatitis C virus infection. Acta Obstet Gynecol Scand 2002 feb;81(2):99-103.

  7. Bacq Y, Sapey T, Bréchot MC, Pierre F, Fignon A, Dubois F. Intrahepatic cholestasis of pregnancy: a French prospective study. Hepatology 1997 ago;26(2):358-64.

  8. Reyes H. Review: intrahepatic cholestasis. A puzzling disorder of pregnancy. J Gastroenterol Hepatol 1997 mar;12(3):211-6.

  9. 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 2004 jul;111(7):676-81.

  10. Heinonen S, Kirkinen P. Pregnancy outcome with intrahepatic cholestasis. Obstet Gynecol 1999 ago;94(2):189-93.

  11. Rioseco AJ, Ivankovic MB, Manzur A, Hamed F, Kato SR, Parer JT, et al. Intrahepatic cholestasis of pregnancy: a retrospective case-control study of perinatal outcome. Am J Obstet Gynecol 1994 mar;170(3):890-5.

  12. Alsulyman OM, Ouzounian JG, Ames-Castro M, Goodwin TM. Intrahepatic cholestasis of pregnancy: perinatal outcome associated with expectant management. Am J Obstet Gynecol 1996 oct;175(4 Pt 1):957-60.

  13. Reid R, Ivey KJ, Rencoret RH, Storey B. Fetal complications of obstetric cholestasis. Br Med J 1976 abr 10;1(6014):870-2.

  14. Kondrackiene J, Beuers U, Zalinkevicius R, Tauschel H-D, Gintautas V, Kupcinskas L. Predictors of premature delivery in patients with intrahepatic cholestasis of pregnancy. World J Gastroenterol 2007 dic 14;13(46):6226-30.

  15. Laatikainen T, Ikonen E. Fetal prognosis in obstetric hepatosis. Ann Chir Gynaecol Fenn 1975;64(3):155-64.

  16. Chappell LC, Gurung V, Seed PT, Chambers J, Williamson C, Thornton JG. Ursodeoxycholic acid versus placebo, and early term delivery versus expectant management, in women with intrahepatic cholestasis of pregnancy: semifactorial randomised clinical trial. BMJ 2012;344:e3799.

  17. Laatikainen T, Tulenheimo A. Maternal serum bile acid levels and fetal distress in cholestasis of pregnancy. Int J Gynaecol Obstet 1984 abr;22(2):91-4.

  18. Laatikainen T, Ikonen E. Serum bile acids in cholestasis of pregnancy. Obstet Gynecol 1977 sep;50(3):313-8.

  19. Burrows RF, Clavisi O, Burrows E. Interventions for treating cholestasis in pregnancy. Cochrane Database Syst Rev 2001;(4):CD000493.

  20. Rodrigues CM, Marín JJ, Brites D. Bile acid patterns in meconium are influenced by cholestasis of pregnancy and not altered by ursodeoxycholic acid treatment. Gut 1999 sep;45(3):446-52.

  21. Glantz A, Marschall HU, Lammert F, Mattsson LA. Intrahepatic cholestasis of pregnancy: a randomized controlled trial comparing dexamethasone and ursodeoxycholic acid. Hepatology. 2005 dic;42(6):1399-405.

  22. Bacq Y, Sentilhes L, Reyes HB, Glantz A, Kondrackiene J, Binder T, et al. Efficacy of Ursodeoxycholic Acid in Treating Intrahepatic Cholestasis of Pregnancy: a Meta-Analysis. Gastroenterology [Internet]. 2012 ago 11 [citado 2012 ago 20]; disponible a partir de: http://www.ncbi.nlm.nih.gov/pubmed/22892336

  23. Fisk NM, Storey GN. Fetal outcome in obstetric cholestasis. Br J Obstet Gynaecol 1988 nov;95(11):1137-43.

  24. Briozzo G, Perego MC, González MM. Valores de referencia de los ácidos biliares séricos en embarazadas del tercer trimestre. Revista del Hospital Materno Infantil Ramón Sardá 2005; 24:7-11.

  25. Lee RH, Kwok KM, Ingles S, Wilson ML, Mullin P, Incerpi M, et al. Pregnancy outcomes during an era of aggressive management for intrahepatic cholestasis of pregnancy. Am J Perinatol 2008 jun;25(6):341-5.

  26. Roncaglia N, Arreghini A, Locatelli A, Bellini P, Andreotti C, Ghidini A. Obstetric cholestasis: outcome with active management. Eur J Obstet Gynecol Reprod Biol 2002 ene 10;100(2):167-70.

  27. Morrison JJ, Rennie JM, Milton PJ. Neonatal respiratory morbidity and mode of delivery at term: influence of timing of elective caesarean section. Br J Obstet Gynaecol 1995 feb;102(2):101-6.

  28. Liu Y, Qiao F, Liu H, Liu D. Ursodeoxycholic acid in the treatment of intraheptic cholestasis of pregnancy. J Huazhong Univ Sci Technol Med Sci 2006;26(3):350-2.

  29. Oztekin D, Aydal I, Oztekin O, Okcu S, Borekci R, Tinar S. Predicting fetal asphyxia in intrahepatic cholestasis of pregnancy. Arch Gynecol Obstet 2009 dic;280(6):975-9.




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