Intrahepatic cholestasis of pregnancy: correlation of preterm delivery with bile acids.

Amac: Bu cal›flmada, gebelikte gozlenen intrahepatik kolestaz olgular›n›n insidans›, obstetrik ve fetal komplikasyonlar›n›n tan›m- lanmas› ve ortaya konulan sonuclar›n karacier fonksiyon testleri ve safra asitleri ile korelasyonunun deerlendirilmesi amaclan- d›. Yontem: Kliniimizde antenatal takibi yap›lan ve doumu gerceklefltirilen 3710 olgunun 32'sinde gebeliin intrahepatik koles- taz› tan›s› konuldu. Olgular›n obstetrik-medikal hikâyeleri, laboratuvar sonuclar›, belirtilerin bafllama tarihi, kafl›nt› dereceleri, tedaviye cevaplar›, doum zamanlamalar›, yenidoan bebeklerin bilgileri cal›flma protokolune al›nd›. ‹statistiki analizler SPSS 12.0 versiyon kullan›larak yap›ld›. Korelasyonun ortaya konulmas›nda Spearman Rank Korelasyon Analizi kullan›ld›. Bulgular: ‹ntrahepatik kolestaz olgular›n›n insidans› %0.86 olarak bulundu. Semptomlar 32. hafta civar›nda gozlendi. Multipar olgular›n %16,6's›nda daha onceki gebelikte, gebeliin intrahepatik kolestaz›n›n gozlendii, tum olgular›n ise %21,8'inde aile oykusunun ol- duu saptand›. Semptomlar›n gozlenme zaman›n›n mevsimlere gore deifltii ve bunun istatistiki olarak anlaml› olduu gozlendi (p<0.05). Olgular›n›n buyuk counluunun (%69.5) k›fl aylar›nda veya ilkbahar bafllar›nda gozlendii ortaya konuldu. Hicbir ol- guda klinik olarak sar›l›k, kanamaya meyil veya fetal olum gozlenmedi. Ursadeoksikolik asit ile kafl›nt› fliddeti azald›. Erken do- ¤um gozlenen olgularda ise serum safra asitlerinin daha yuksek olduu ortaya konuldu (r=0.409, p=0.038). Sonuc: Total safra asit- leri erken doum ile koreledir. 38. haftalarda doum planlamas› ile perinatal outcome iyilefltirilebilir. Anahtar kelimeler: Gebeliin intrahepatik kolestaz›, safra asitleri, perinatal outcome, preterm doum Background/aims: The aim of this study was to determine the incidence, obstetrical and fetal complication rates of intrahepatic cholestasis of pregnancy in patients managed actively around 38 weeks and evaluate the correlation of these results with liver func- tion tests and bile acids. Material and Methods: In this cohort study 3710 women were booked for delivery, of which 32 pregnant women were diagnosed as intrahepatic cholestasis of pregnancy. All data concerning obstetric- medical history, laboratory results, symptom onset time, pruritus degree, treatment response, and delivery time and infants information were recorded in the study pro- tocol. Statistical analyses were conducted with SPSS 12.0 version and correlations were assessed by Spearman Rank correlation analysis. Results: The incidence of intrahepatic cholestasis of pregnancy was 0.86%. The symptoms appeared around 32 weeks. 16.6% multiparas had a previously affected pregnancy and 21.8% of intrahepatic cholestasis of pregnancy patients had family his- tory of intrahepatic cholestasis of pregnancy. Symptom onset varied according to season (p<0.05). Most patients (69.5%) were diag- nosed in winter and the beginning of spring. There were no reported cases of clinical maternal jaundice, bleeding tendency or still- birth. Pruritus was decreased by ursodeoxycholic acid treatment. Total bile acids tended to be higher in patients with preterm deli- very (r=0.409, p=0.038). Conclusion: Total bile acids are correlated with preterm delivery. An attempt to deliver at around 38 we- eks may improve perinatal outcome.