Verma Ashish, Kumar Ishan, Kumari Anisha, Pandey Uma, Singh Pramod Kumar
Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
Department of Obstetrics and Gynaecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
Abdom Radiol (NY). 2025 Jun 2. doi: 10.1007/s00261-025-04986-w.
Intrahepatic cholestasis of pregnancy (ICP) is a liver disorder that occurs during pregnancy, typically in the third trimester, and is associated with adverse fetal outcomes. Despite being well-recognized, the exact pathogenesis of ICP remains incompletely understood, with impaired hepatobiliary function hypothesized to play a significant role in its development.
The study aims to evaluate the relationship between altered gallbladder motility and hepatobiliary dysfunction in pregnancies complicated by ICP.
This was a prospective hospital-based study involving 90 participants: 30 non-pregnant controls and 60 pregnant women (30 with intrahepatic cholestasis of pregnancy (ICP), and 30 pregnant controls). The cholestasis group was further subdivided into an icteric group (elevated serum bilirubin levels) and an anicteric group (abnormal liver function tests but normal bilirubin levels). Gallbladder volume (GBV) was initially measured after an overnight fast (12-14 h). Following a standardized meal (75 g of bread and butter or 100 g of groundnut), GBV and ejection fraction were re-measured at multiple postprandial time points (15, 30, 45, 60, 75, and 90 min).
The study enrolled 60 pregnant women in their third trimester (gestational weeks 28-40) and 30 non-pregnant controls. Among the pregnant women, 30 were diagnosed with ICP, which was further divided into an icteric group (n = 6) and an anicteric group (n = 24). The ICP group demonstrated consistently higher GB volumes and lower ejection fraction (EF) compared to non-pregnant and pregnant controls, with statistically significant differences across all time intervals. Within the ICP patients, the icteric group consistently exhibited higher GB volumes and lower EF values compared to anicteric group. Receiver operating characteristic (ROC) curve analysis revealed that the best post-prandial 15-min GB ejection fraction cutoff for predicting ICP was 53% and postprandial 15-min GB volume cutoff for predicting ICP was 9.5 ml, CONCLUSION: Impaired gallbladder motility, characterized by increased GB volume and decreased EF, is a key feature of obstetric cholestasis. Gallbladder ultrasound measurements, particularly postprandial GB volume and EF, can serve as useful diagnostic tools for distinguishing between cholestasis of pregnancy and healthy pregnancies, with high sensitivity and specificity for identifying ICP in late pregnancy.
妊娠期肝内胆汁淤积症（ICP）是一种在孕期发生的肝脏疾病，通常在妊娠晚期出现，并与不良胎儿结局相关。尽管已被广泛认识，但ICP的确切发病机制仍未完全明确，推测肝胆功能受损在其发展过程中起重要作用。
本研究旨在评估妊娠合并ICP患者胆囊运动改变与肝胆功能障碍之间的关系。
这是一项基于医院的前瞻性研究，共纳入90名参与者：30名非妊娠对照者和60名孕妇（30名妊娠期肝内胆汁淤积症（ICP）患者和30名妊娠对照者）。胆汁淤积组进一步分为黄疸组（血清胆红素水平升高）和无黄疸组（肝功能检查异常但胆红素水平正常）。胆囊容积（GBV）在禁食过夜（12 - 14小时）后首次测量。在进食标准化餐食（75克面包和黄油或100克花生）后，在多个餐后时间点（15、30、45、60、75和90分钟）重新测量GBV和射血分数。
本研究纳入了60名妊娠晚期（孕周28 - 40周）的孕妇和30名非妊娠对照者。在孕妇中，30名被诊断为ICP，进一步分为黄疸组（n = 6）和无黄疸组（n = 24）。与非妊娠和妊娠对照者相比，ICP组的GB容积始终较高，射血分数（EF）较低，在所有时间间隔内均有统计学显著差异。在ICP患者中，黄疸组的GB容积始终高于无黄疸组，EF值更低。受试者工作特征（ROC）曲线分析显示，预测ICP的最佳餐后15分钟GB射血分数临界值为53%，预测ICP的最佳餐后15分钟GB容积临界值为9.5毫升。
以GB容积增加和EF降低为特征的胆囊运动功能受损是产科胆汁淤积症的关键特征。胆囊超声测量，尤其是餐后GB容积和EF，可作为区分妊娠期胆汁淤积症和正常妊娠的有用诊断工具，对晚期妊娠ICP的识别具有高敏感性和特异性。
