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THE OUTCOME OF MATERNAL AND FETAL CASES WITH INTRAHEPATIC CHOLESTASIS OF PREGNANCY

Year 2023, Volume: 11 Issue: 3, 177 - 181, 15.10.2023

Abstract

Introductıon and objektive : Intrahepatic cholestasis (ICP) of pregnancy is a common disorder of pregnancy manifested by pruritus and elevated bile acids.Some negative obstetric outcomes of ICP; Spontaneous preterm birth, meconium amniotic fluid, fetal asphyxia and stillbirth have been reported in the literature.
Due to the lack of evidence for diagnosis, treatment, and concomitant adverse outcomes, management has two main goals: reducing troubling symptoms and perinatal morbidity and mortality.
Methods: Medical records of patients diagnosed and followed up with intrahepatic pregnancy cholestasis between January 2017 and June 2021 were reviewed retrospectively.
Results: The mean week of delivery of the patients was 38.1±1.4, and no fetal or neonatal death occurred during their follow-up.
Conclusion: With respect to the increased risk of adverse neonatal outcomes and stillbirth in patients with ICP, timing of birth in maternal ICP patients should be carefully evaluated. In conclusion, there is some evidence to suggest that birth at 37th weeks, especially in patients with severe bile acid level elevations, may improve outcomes. However as a result of this study in which the average gestational age at birth was 38 weeks and no fetal mortality occurred, we suggest that with close monitoring and early administration of treatment birth at 38 weeks could potentially improve outcomes in patients with low bile acid levels. Furthermore, optimal timing for birth in patients with ICP is as of yet unknown, due to the absence of randomized studies evaluating elective early induction of labor.

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References

  • 1.Clinical Updates in Women's Health Care Sum- mary: Liver Disease: Reproductive Considerations. Obstet Gynecol 2017; 129: 236.
  • 2.Chen Y, Vasilenko A, Song X, et al. Estrogen and estrogen receptor-α-mediated transrepression of bile salt export pump. Mol Endocrinol. 2015;29: 613–626.
  • 3. Manzotti C, Casazza G, Stimac T, et al. Total serum bile acids or serum bile acid profile, or both, for the diagnosis of intrahepatic cholestasis of pregnancy. Cochrane Database Syst Rev. 2019 Jul 05;7:1-90.
  • 4. Ovadia C, Seed PT, Sklavounos A, et al. Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results of aggregate and individual patient data meta-analyses. Lancet. 2019;393:899–909.
  • 5. Bicocca MJ, Sperling JD, Chauhan SP. Intrahepatic cholestasis of pregnancy: a review of six national and regional guidelines. Eur J Obstet Gynecol. 2018;231:180–187
  • 6. Abu-Hayyeh S, Papacleovoulou G, Lövgren-Sand- blom A, et al. Intrahepatic cholestasis of pregnancy levels of sulfated progesterone metabolites inhibit farnesoid X receptor resulting in a cholestatic phenotype. Hepatology. 2013;57:716–726.
  • 7. Marschall HU, Wikström Shemer E, Ludvigsson JF, et al. Intrahepatic cholestasis of pregnancy and associated hepatobiliary disease: a population-based cohort study. Hepatology. 2013:58;1385-1391.
  • 8. Williamson C, Miragoli M, Sheikh Abdul Kadir S, et al. Bile acid signaling in fetal tissues: Implications for intrahepatic cholestasis of preg- nancy. Dig Dis.2011;29:58–61.
  • 9. Williamson C, Geenes V. Intrahepatic cholestasis of pregnancy. Obstet Gynecol. 2014;124:120–133.
  • 10. Geenes V, Williamson C. Intrahepatic cholestasis of pregnancy. World J Gastroenterol. 2009;15: 2049–2066.
  • 11. Glantz A, Marschall HU, Mattsson LÅ. Intrahepatic cholestasis of pregnancy: relationships between bile acid levels and fetal complication rates. Hepatology. 2004;40:467–474 .
  • 12. Kong X, Kong Y, Zhang F, et al. Evaluating the effectiveness and safety of ursodeoxycholic acid intreatment of intrahepatic cholestasis of pregnancy: a meta-analysis [a prisma-compliant study]. Med [United States]. 2016;95:40-49.
  • 13. Kondrackiene J, Beuers U, Kupcinskas L: Efficacy and safety of ursodeoxycholic acid versus cholestyramine in intrahepatic cholestasis of pregnancy. Gastroenterology. 2005, 129:894-901. 10.1053/j.gastro.2005.06.019.
  • 14. Bacq Y, Sentilhes L, Reyes HB, et al. Efficacy of ursodeoxycholic acid in treating intrahepatic cholestasis of pregnancy: a meta-analysis. Gastroenterology. 2012;143:1492–1501.
  • 15. Gurung V, Stokes M, Middleton P, et al. Interventions for treating cholestasis in pregnancy. The Cochrane Database of Systematic Reviews, 2013; 2013[6]:CD000493.
  • 16. Grand’Maison S, Durand M, Mahone M. The effects of ursodeoxycholic acid treatment for intrahepatic cholestasis of pregnancy on maternal and fetal outcomes: a meta-analysis including non-randomized studies. J Obstet Gynaecol Canada. 2014;36:632–641.
  • 17. Hanns-Ulrich Marschall 1, Elisabeth Wikström Shemer, et al. Intrahepatic cholestasis of pregnancy and associated hepatobiliary disease: a population-based cohort study Affiliations expand Hepatology 2013 Oct;58[4]:1385-91. doi: 10.1002/hep.26444.
  • 18. Snape WJ, Shiff S, Cohen S. Effect of deoxycholic acid on colonic motility in the rabbit. Am J Physiol Liver Physiol. 1980;1:321–325.
  • 19. McPherson C, Inder T. Perinatal and neonatal use of sedation and analgesia. Semin Fetal Neonatal Med. 2017;22[5]:314-320.
  • 20. Palma J, Reyes H, Ribalta J, et al. Effects of ursodeoxycholic acid in patients with intrahepatic cholestasis of pregnancy. Hepatology. 1992;15: 1043–1047.
  • 21. Chappell LC, Bell JL, Smith A, et al. Ursodeoxycholic acid versus placebo in women with intrahepatic cholestasis of pregnancy [PITCHES]: randomized controlled trial. Lancet. 2019; 394:849–860.
  • 22. 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. e1–667.e5.
  • 23. Gantt AB., Miller RS. ACOG Committee Opinion. Medically indicated late-preterm and early-term deliveries. Obstet Gynecol. 2021;138: e35-e39.

GEBELİK İNTRAHEPATİK KOLESTAZ OLGULARININ MATERNAL VE NEONATAL SONUÇLARI

Year 2023, Volume: 11 Issue: 3, 177 - 181, 15.10.2023

Abstract

Giriş ve amaç: Gebelikte intrahepatik kolestaz (ICP), kaşıntı ve safra asitlerinin yükselmesi ile kendini gösteren, gebelikte sık görülen bir hastalıktır. ICP'nin bazı olumsuz obstetrik sonuçları; Literatürde spontan erken doğum, mekonyumlu amniyotik sıvı, fetal asfiksi ve ölü doğum bildirilmektedir.
Tanı, tedavi ve eşlik eden olumsuz sonuçlara ilişkin kanıtların bulunmaması nedeniyle, tedavinin iki ana hedefi vardır: rahatsız edici semptomları ve perinatal morbidite ve mortaliteyi azaltmak.
Yöntemler: Ocak 2017 ile Haziran 2021 tarihleri arasında intrahepatik gebelik kolestazı tanısı konularak takip edilen hastaların tıbbi kayıtları geriye dönük olarak incelendi.
Bulgular: Hastaların ortalama doğum haftası 38,1±1,4 olup, takipleri sırasında herhangi bir fetal veya neonatal ölüm yaşanmadı.
Sonuç: İCP'li hastalarda olumsuz neonatal sonuçlar ve ölü doğum riskinin artması nedeniyle, anne İCP'li hastaların doğum zamanlaması dikkatle değerlendirilmelidir. Sonuç olarak, özellikle ciddi safra asidi yüksekliği olan hastalarda 37. haftada doğumun sonuçları iyileştirebileceğini gösteren bazı kanıtlar vardır. Ancak doğumda ortalama gebelik yaşının 38 hafta olduğu ve fetal mortalitenin görülmediği bu çalışmanın sonucunda, yakın takip ve tedavinin erken uygulanmasıyla 38. haftada doğumun düşük safra asidi düzeyi olan hastalarda sonuçları potansiyel olarak iyileştirebileceğini düşünüyoruz. . Ayrıca, ICP'li hastalarda doğumun optimal zamanlaması, elektif erken doğum indüksiyonunu değerlendiren randomize çalışmaların bulunmaması nedeniyle henüz bilinmemektedir.

References

  • 1.Clinical Updates in Women's Health Care Sum- mary: Liver Disease: Reproductive Considerations. Obstet Gynecol 2017; 129: 236.
  • 2.Chen Y, Vasilenko A, Song X, et al. Estrogen and estrogen receptor-α-mediated transrepression of bile salt export pump. Mol Endocrinol. 2015;29: 613–626.
  • 3. Manzotti C, Casazza G, Stimac T, et al. Total serum bile acids or serum bile acid profile, or both, for the diagnosis of intrahepatic cholestasis of pregnancy. Cochrane Database Syst Rev. 2019 Jul 05;7:1-90.
  • 4. Ovadia C, Seed PT, Sklavounos A, et al. Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results of aggregate and individual patient data meta-analyses. Lancet. 2019;393:899–909.
  • 5. Bicocca MJ, Sperling JD, Chauhan SP. Intrahepatic cholestasis of pregnancy: a review of six national and regional guidelines. Eur J Obstet Gynecol. 2018;231:180–187
  • 6. Abu-Hayyeh S, Papacleovoulou G, Lövgren-Sand- blom A, et al. Intrahepatic cholestasis of pregnancy levels of sulfated progesterone metabolites inhibit farnesoid X receptor resulting in a cholestatic phenotype. Hepatology. 2013;57:716–726.
  • 7. Marschall HU, Wikström Shemer E, Ludvigsson JF, et al. Intrahepatic cholestasis of pregnancy and associated hepatobiliary disease: a population-based cohort study. Hepatology. 2013:58;1385-1391.
  • 8. Williamson C, Miragoli M, Sheikh Abdul Kadir S, et al. Bile acid signaling in fetal tissues: Implications for intrahepatic cholestasis of preg- nancy. Dig Dis.2011;29:58–61.
  • 9. Williamson C, Geenes V. Intrahepatic cholestasis of pregnancy. Obstet Gynecol. 2014;124:120–133.
  • 10. Geenes V, Williamson C. Intrahepatic cholestasis of pregnancy. World J Gastroenterol. 2009;15: 2049–2066.
  • 11. Glantz A, Marschall HU, Mattsson LÅ. Intrahepatic cholestasis of pregnancy: relationships between bile acid levels and fetal complication rates. Hepatology. 2004;40:467–474 .
  • 12. Kong X, Kong Y, Zhang F, et al. Evaluating the effectiveness and safety of ursodeoxycholic acid intreatment of intrahepatic cholestasis of pregnancy: a meta-analysis [a prisma-compliant study]. Med [United States]. 2016;95:40-49.
  • 13. Kondrackiene J, Beuers U, Kupcinskas L: Efficacy and safety of ursodeoxycholic acid versus cholestyramine in intrahepatic cholestasis of pregnancy. Gastroenterology. 2005, 129:894-901. 10.1053/j.gastro.2005.06.019.
  • 14. Bacq Y, Sentilhes L, Reyes HB, et al. Efficacy of ursodeoxycholic acid in treating intrahepatic cholestasis of pregnancy: a meta-analysis. Gastroenterology. 2012;143:1492–1501.
  • 15. Gurung V, Stokes M, Middleton P, et al. Interventions for treating cholestasis in pregnancy. The Cochrane Database of Systematic Reviews, 2013; 2013[6]:CD000493.
  • 16. Grand’Maison S, Durand M, Mahone M. The effects of ursodeoxycholic acid treatment for intrahepatic cholestasis of pregnancy on maternal and fetal outcomes: a meta-analysis including non-randomized studies. J Obstet Gynaecol Canada. 2014;36:632–641.
  • 17. Hanns-Ulrich Marschall 1, Elisabeth Wikström Shemer, et al. Intrahepatic cholestasis of pregnancy and associated hepatobiliary disease: a population-based cohort study Affiliations expand Hepatology 2013 Oct;58[4]:1385-91. doi: 10.1002/hep.26444.
  • 18. Snape WJ, Shiff S, Cohen S. Effect of deoxycholic acid on colonic motility in the rabbit. Am J Physiol Liver Physiol. 1980;1:321–325.
  • 19. McPherson C, Inder T. Perinatal and neonatal use of sedation and analgesia. Semin Fetal Neonatal Med. 2017;22[5]:314-320.
  • 20. Palma J, Reyes H, Ribalta J, et al. Effects of ursodeoxycholic acid in patients with intrahepatic cholestasis of pregnancy. Hepatology. 1992;15: 1043–1047.
  • 21. Chappell LC, Bell JL, Smith A, et al. Ursodeoxycholic acid versus placebo in women with intrahepatic cholestasis of pregnancy [PITCHES]: randomized controlled trial. Lancet. 2019; 394:849–860.
  • 22. 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. e1–667.e5.
  • 23. Gantt AB., Miller RS. ACOG Committee Opinion. Medically indicated late-preterm and early-term deliveries. Obstet Gynecol. 2021;138: e35-e39.
There are 23 citations in total.

Details

Primary Language English
Subjects Surgery (Other), Medical Education, Health Services and Systems (Other)
Journal Section Original Articles
Authors

Züat Acar 0000-0002-3485-1554

Yunus Çavuş 0000-0001-5739-3106

Yusuf Başkıran 0000-0003-1123-6062

Publication Date October 15, 2023
Acceptance Date October 7, 2023
Published in Issue Year 2023 Volume: 11 Issue: 3

Cite

Vancouver Acar Z, Çavuş Y, Başkıran Y. THE OUTCOME OF MATERNAL AND FETAL CASES WITH INTRAHEPATIC CHOLESTASIS OF PREGNANCY. pediatr pract res. 2023;11(3):177-81.