Conti-Ramsden Frances, McEwan Michael, Hill Rachel, Wade Julie, Abraham Georgina, Buckeldee Olivia, Williamson Catherine, Knight Caroline L, Girling Joanna, Chappell Lucy C
Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK.
West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
Obstet Med. 2020 Dec;13(4):185-191. doi: 10.1177/1753495X19868873. Epub 2019 Sep 2.
Current guidelines recommend viral, autoimmune, coagulation and liver ultrasound testing in intrahepatic cholestasis of pregnancy to exclude alternative diagnoses.
Electronic health records were searched for investigations and diagnoses in women with raised bile acid concentrations (>10 µmol/L) between January 2016 and December 2017 at two UK maternity units.
Five hundred and thirty-one women had a raised bile acid concentration (median (IQR): 18 (13-32 µmol/L)) at a median gestation of 35.1 (IQR 31.8-37.0) weeks. Out of 531 women, 250 (47.1%) had full virology, autoimmune and ultrasound tests, and 348 (65.5%) had coagulation performed. Positive hepatitis B and C results were previously known. No new Epstein-Barr virus, cytomegalovirus or hepatitis A diagnoses were made. There were 11 positive autoimmune results, but no new diagnoses. No woman had an unexplained prolonged prothrombin time. No ultrasound liver ( = 38) or gallbladder ( = 85) abnormalities were of acute clinical significance.
Intrahepatic cholestasis of pregnancy investigations provided no new diagnoses that influenced clinical management during pregnancy.
当前指南建议对妊娠肝内胆汁淤积症患者进行病毒学、自身免疫、凝血功能及肝脏超声检查，以排除其他诊断。
检索2016年1月至2017年12月期间英国两家产科单位胆汁酸浓度升高（>10 µmol/L）女性的电子健康记录，以获取相关检查及诊断信息。
531名女性在妊娠35.1（四分位间距31.8 - 37.0）周时胆汁酸浓度升高（中位数（四分位间距）：18（13 - 32 µmol/L））。在这531名女性中，250名（47.1%）进行了全面的病毒学、自身免疫及超声检查，348名（65.5%）进行了凝血功能检查。乙肝和丙肝检测结果为阳性的情况此前已知。未发现新的爱泼斯坦 - 巴尔病毒、巨细胞病毒或甲型肝炎诊断病例。有11例自身免疫检查结果呈阳性，但未发现新的诊断病例。没有女性的凝血酶原时间延长原因不明。未发现具有急性临床意义的肝脏超声异常（n = 38）或胆囊超声异常（n = 85）。
妊娠肝内胆汁淤积症的检查未发现影响孕期临床管理的新诊断病例。
