Kudret ERKENEKLİ, Cantekin ISKENDER, Hasan TOPÇU, Tugba ENSAR, Dilek UYGUR, Nuri DANİSMAN

Gebelik Kolestazlı Gebelerde Safra Asit Seviyeleri Perinatal Komplikasyonları Tahmin Etmede Yardımcı mıdır?

Amaç: Gebelik kolestazlı gebelerin gebelik sonuçlarının ve postprandial serum safra asit seviyelerinin perinatal komplikasyonları ile ilişkisinin değerlendirilmesi. Materyal ve Metod: Bu retrospektif çalışma Ocak 2008 ve Haziran 2013 arasında gebelik kolestazı tanısı alan 103 hastayı içermektedir. Hastaların yaşları, obstetrik hikayeleri, gebelik sonuçları, maternal ve neonatal komplikasyonları, ursedeoksikolik asit tedavisi ve serum labaratuar testleri hastaların medikal kayıtlarından elde edildi. Receiver operating karakteristik analizleri açlık ve postprandial safra asitleri seviyelerinin perinatal komplikasyonları tahmin etme gücünü değerlendirmek için kullanıldı. Araştırma Makalesi / Research Article 212 Cilt/Volume 40 Yıl/Year 2015 Postprandial Bile Acids in ICP Bulgular: Gestasyonel diyabet ve preterm doğum intrahepatik kolestazlı gebelerde daha sıklıkla izlendi. Primer sezeryan oranı intrahepatik kolestazlı hastalarda daha yaygındı. Gelişme geriliği oluşan fetusların oranı ursodeoksikolik asit kullanan kadınlarda daha yüksekti. Ursodeoksikolik asit kullanımından bağımsız olarak intrahepatik kolestazlı tüm gebelerde neonatal yoğun bakım ihtiyacı ve spontan preterm doğumların dahil olduğu tüm neonatal komplikasyonların görülme oranı benzerdi. Receiver operating karakteristik analizinde postprandial ve açlık safra asit seviyelerinin gebelik kompliksayonlarını tahmin etme gücü sırasıyla 0,64 ve 0,70 idi. Sonuç: Gebelik kolestazı preterm doğum ve neonatal morbiditi gibi perinatal komplikasyonları kesin olarak arttırmaktadır. Postprandial safra asit seviyesi açlık safra asit seviyesine göre obstetik komplikasyonları tahmin etmede daha değersiz bulunmuştur ve ursodeoksikolik asit tedavisi perinatal sonuçların üzerinde etkili bulunamamıştır

Anahtar Kelimeler:

Gebelik komplikasyonları, intrahepatik kolestaz, postprandial safra asitleri

Are Postprandial Bile Acid Levels Helpful in Predicting Perinatal Complications in Patients with Intrahepatic Cholestasis of Pregnancy?

Purpose: To determine the outcomes of Iintrahepatic cholestasis of pregnancy and the role of postprandial serum bile acid levels in the prediction of perinatal complications. Material and Methods: This retrospective study consisted of 103 patients with intrahepatic cholestasis of pregnancy between January 2008 and June 2013. Maternal age, obstetric history, pregnancy outcome, maternal and neonatal complications, ursodeoxycholic acid treatment during pregnancy and serum laboratory tests were retrieved from patients’ medical records. Receiver operating characteristic analysis was used to evaluate the performance of fasting and postprandial serum bile acid levels to predict perinatal complications. Results: Gestational diabetes and preterm delivery occurred more frequently in patients with intrahepatic cholestasis of pregnancy patients. The rate of primary cesarean delivery was more common in in patients with intrahepatic cholestasis of pregnancy patients. The rate of growth-restricted infants was higher in the patients who received ursodeoxycholic acid. Nenoatal intensive care unit admissions and overall neonatal complications, as well as spontaneous preterm deliveries, were similar among in patients with intrahepatic cholestasis of pregnancy regardless of ursodeoxycholic acid therapy. In the receiver operating characteristic analysis, the area under curve values for postprandial and fasting bile acids to predict neonatal complications were 0.64 and 0.70, respectively. Conclusion: Intrahepatic cholestasis of pregnancy patients increases certain perinatal complications, such as preterm deliveries and neonatal morbidity. Postprandial serum bile acid levels are inferior to fasting serum bile acid levels in the prediction of obstetric complications. ursodeoxycholic acid does not seem to improve perinatal outcomes

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