Kenyon Anna P, Piercy C Nelson, Girling J, Williamson C, Tribe R M, Shennan A H
Guy's, Kings' and St Thomas' Hospital School of Medicine, Maternal and Fetal Research Unit, St Thomas' Hospital, London, UK.
BJOG. 2002 Mar;109(3):282-8. doi: 10.1111/j.1471-0528.2002.01368.x.
To determine the nature and outcome of obstetric cholestasis in a United Kingdom population.
Prospective analysis of clinical outcome in women diagnosed with obstetric cholestasis that is actively managed.
Antenatal population of three London hospitals between August 1999 and April 2001.
Seventy women with obstetric cholestasis defined as abnormal liver function (one or more abnormality in gamma-glutamyl transpeptidase, alanine amino-transferase, aspartate amino-transferase and total bile acids) in a pregnant woman with pruritus, in the absence of other pathology.
All women were interviewed weekly regarding their symptoms. All were actively managed according to a standardised protocol, which included early delivery before 38 weeks. Obstetric outcome was recorded.
Seventy women of mean age 30 (6) years delivered 73 infants. The median gestation at onset of pruritus was 30 (range 4-39) weeks and at diagnosis of obstetric cholestasis was 33.7 (range 21-40.7) weeks. Asian women were more likely to be diagnosed with obstetric cholestasis. Pruritus was usually severe and generalised, and commonly worst on the palms and/or soles of the feet. There were no stillbirths or perinatal deaths. Twenty-five women required caesarean section (36%); only four (16%) were for fetal distress. Twelve women (17%) delivered before 37 weeks, of which eight (67%) were iatrogenic. Ten (14%) infants required admission to the special care baby unit of which four (40%) were ventilated.
Policies of active management result in increased intervention and associated complications. This must be balanced against possible reductions in perinatal mortality.
确定英国人群中产科胆汁淤积症的性质及结局。
对确诊为产科胆汁淤积症并接受积极治疗的女性的临床结局进行前瞻性分析。
1999年8月至2001年4月间伦敦三家医院的产前人群。
70名患有产科胆汁淤积症的女性，定义为孕期出现瘙痒且肝功能异常（γ-谷氨酰转肽酶、丙氨酸氨基转移酶、天冬氨酸氨基转移酶和总胆汁酸中一项或多项异常），且无其他病理情况。
每周对所有女性进行症状询问。所有患者均按照标准化方案进行积极治疗，包括在38周前提前分娩。记录产科结局。
70名平均年龄为30（6）岁的女性分娩了73名婴儿。瘙痒开始时的中位孕周为30（范围4 - 39）周，诊断为产科胆汁淤积症时的中位孕周为33.7（范围21 - 40.7）周。亚洲女性更易被诊断为产科胆汁淤积症。瘙痒通常严重且全身性，常见于手掌和/或脚底最为严重。无死产或围产期死亡。25名女性（36%）需要剖宫产；其中仅4名（16%）因胎儿窘迫。12名女性（17%）在37周前分娩，其中8名（67%）为医源性。10名（14%）婴儿需要入住特殊护理婴儿病房，其中4名（40%）需要通气。
积极治疗策略会导致干预措施增加及相关并发症。这必须与围产期死亡率可能的降低相权衡。
