Carballo-Núñez Elba, González-Rodríguez Laura, González-Boubeta Roberto, María Teresa Alves-Pérez
Ginecol Obstet Mex. 2015 Dec;83(12):776-84.
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 40pml/L have been associated with adverse perinatal outcomes.
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 peninatal outcomes.
Retrospective descriptive study of 71 women diagnosed of intrahepatic cholestasis in the years 2006-201 1 in the University of Vigo Clinical Hospital Complex (Spain).
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).
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.
产科胆汁淤积症与早产、产时胎粪、胎儿窘迫及宫内胎儿死亡风险增加相关。对于这些并发症各自的发生频率以及血清胆汁酸和转氨酶水平的预后价值，目前尚无共识。胆汁酸水平高于40pml/L与不良围产期结局相关。
确定单胎妊娠合并妊娠胆汁淤积症时不良围产期结局的发生频率，并评估母血清中胆汁酸和转氨酶水平与围产期结局之间的关联。
对2006 - 2011年在西班牙维戈大学临床医院综合体诊断为肝内胆汁淤积症的71名女性进行回顾性描述性研究。
诊断时的平均孕周为35周6天，10%的婴儿早产。有1例宫内胎儿死亡（1.4%）。我们发现18.3%的产妇产时出现胎粪。因胎儿窘迫，5.6%的分娩进行了剖宫产。没有新生儿Apgar评分<7或脐动脉pH<7。75.5%的婴儿未出现呼吸窘迫，而5例（6.75%）出现严重窘迫。我们发现不良围产期结局与胆汁酸水平之间无统计学显著关联。转氨酶水平升高与早产（p = 0.009；p = 0.010）和严重窘迫（p = 0.027；p = 0.008）相关。
我们研究系列中观察到的不良结局发生率较低可能与早产率低有关。生化特征和临床特征均不适用于预测胎儿并发症。
