Taze ve dondurulmuş embriyo transferlerinde intrahepatik kolestaz insidansı ve maternal perinatal sonuçların karşılaştırılması

Amaç: Taze ve dondurulmuş çözülmüş embriyo transferi (ET) gebeliklerinde intrahepatik kolestazın perinatal ve maternal sonuçlarını karşılaştırmak. Gereç ve Yöntem: Bu araştırma, Ekim 2010-Ocak 2021 tarihleri arasında hastanemize başvuran 45 gebe kadın ile retrospektif olarak yapılmıştır. Grup:1 (Dondurulmuş çözülmüş; n:21) ve Grup:2 (Taze: n:24) olmak üzere iki grup belirlenmiştir. Vücutta yaygın kaşıntı ve yüksek açlık safra asitleri (FBA) seviyeleri (10 mmol/L’den fazla) tanı kriteri olarak kabul edildi. Dışlama kriterleri spontan gebelikler, çoğul gebelikler, kronik karaciğer hastalığı öyküsü idi. İstatistiksel analiz için SPSS, versiyon 26 kullanıldı. Bulgular: Yaş, vücut kitle indeksi (VKİ), sigara içme durumu, deneme sayısı, gestasyonel diabetes mellitus (GDM), infertilite türleri ve polikistik over sendromu (PCOS) insidansı açısından iki grup arasında istatistiksel olarak anlamlı bir fark bulunmamıştır (p >0.05). Doğum şekli, cinsiyet, konjenital anomali, mekonyum aspirasyon sendromu (MAS), doğumdaki yenidoğan ağırlığı, yenidoğan yoğun bakım ünitesi (YYBB), doğumdaki gebelik yaşı ve 5 dk Apgar skoru da karşılaştırılmış ve anlamlı fark bulunamamıştır (p>0.05). Sonuç: Bu çalışma, donmuş çözülmüş ve fresh tüp bebek gebeliklerinin maternal özellikler ve perinatal sonuçlar açısından farklılık göstermediğini desteklemektedir.

Anahtar Kelimeler:

Gebeliğin intrahepatik kolestazı, taze embriyo transferi, donmuş çözülmüş embriyo transferi, perinatal sonuçlar

Comparison of intrahepatic cholestasis incidence and maternal perinatal outcomes in fresh and frozen embryo transfers

Objective: To compare the perinatal and maternal results of intrahepatic cholestasis (ICP) in fresh and frozen-thawed embryo transfer (ET) pregnancies. Material and Method: This research was performed retrospectively, including fourty-five pregnant women applied to our hospital between October 2010 and January 2021. Two groups have been determined, group:1 (Frozen thawed; n:21) and group:2 (Fresh; n:24). Common pruritus in the body and high fasting bile acids (FBA) levels (greater than 10 mmol/L) were accepted as diagnostic criteria. The exclusion criteria were spontaneous pregnancies, multiple pregnancies, chronic liver disease history. SPSS, version 26 was used for statistical analysis. Results: Statistically significant difference could not be associated between the two groups regarding age, maternal body mass index (BMI), smoking status, number of trials, gestational diabetes mellitus (GDM), types of infertility and polycystic ovary syndrome (PCOS) incidence (p-value >0.05). The way of birth, gender, congenital anomaly, need for meconium aspiration syndrome (MAS), weight of newborn at birth, neonatal intensive care unit (NICU), gestational age at birth and 5 min Apgar score also compared and significantly difference could not be associated between two groups (p-value > 0.05). Conclusion: This study supports the fact that frozen-thawed and fresh in vitro fertilization (IVF) pregnancies in terms of maternal characteristics and perinatal results have no difference.

Keywords:

Intrahepatic cholestasis of pregnancy, fresh embryo transfer, frozen-thawed embryo transfer, perinatal outcomes,

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Chappell LC, Bell JL, Smith A, et al. PITCHES study group. Ursodeoxycholic acid versus placebo in women with intrahepatic cholestasis of pregnancy (PITCHES): a randomised controlled trial. Lancet 2019; 394: 849-60.
Dokuzeylül Gungor N, Gurbuz T. Pregnancy outcomes of intrauterine insemination in age-matched young women according to serum anti-mullerian hormone levels. JRM, 2021; 66: 195-202.
Gürbüz T,Gökmen O,Dokuzeylül Gungor N, Polikistik over sendromu bulunan kadınlarda glikoz potasyum oranının tanısal değerinin insülin ile karşılaştırılması. CUMJ 2021; 46: 381-6.
Gürbüz T, Dokuzeylül Gungor N. Hiperemezis gravidarum etiyopatogenezinde vitamin D eksikliğinin rolü var mı? Adıyaman Üni.Sağlık Bilimleri Derg 2018; 4: 761-71.
Dokuzeylul Gungor N, Gurbuz T,Ture T. Prolonged luteal phase support with progesterone may increase papules and plaques of pregnancy frequency in pregnancies through in vitro fertilization. An Bras Dermatol 2021; 96: 171-5.
Floreani, A. and M.T. Gervasi, New insights on intrahepatic cholestasis of pregnancy. Clin Liver Dis 2016; 20: 177-89.
Reyes H. Intrahepatic cholestasis. A puzzling disorder of pregnancy. J Gastroenterol Hepatol 1997; 12: 211-6.
Tran TT, Ahn J, Reau NS. ACG Clinical Guideline: Liver Disease and Pregnancy. Am J Gastroenterol 2016; 111: 176-94.
Reyes H. What have we learned about intrahepatic cholestasis of pregnancy? Hepatology 2016; 63: 4-8.
Diken Z, Usta IM, Nassar AH. A clinical approach to intrahepatic cholestasis of pregnancy. Am J Perinatol 2014; 31: 1-8.
Mutlu MF, Aslan K, Guler I, et al. Two cases of first onset intrahepatic cholestasis of pregnancy associated with moderate ovarian hyperstimulation syndrome after IVF treatment and review of the literature. J Obstet Gynaecol 2017 37: 547-9.
Batsry L, Zloto K, Kalter A, Baum M, Mazaki-Tovi S, Yinon Y. Perinatal outcomes of intrahepatic cholestasis of pregnancy in twin versus singleton pregnancies: is plurality associated with adverse outcomes? Arch Gynecol Obstet 2019; 300: 881-7.
Ovadia C, Seed PT, Sklavounos A, et al. Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results of aggregate and individual patient data meta-analyses. Lancet 2019; 393: 899-909.
Goulis DG, Walker IA, de Swiet M, Redman CW, Williamson C. Preeclampsia with abnormal liver function tests is associated with cholestasis in a subgroup of cases. Hypertens Pregnancy 2004; 23: 19-27.
Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007; 39:175-91.
Alemdaroğlu S, Yılmaz Baran Ş, Durdağ GD, et al. Intrahepatic cholestasis of pregnancy: are in vitro fertilization pregnancies at risk? J Matern Fetal Neonatal Med 2021; 34: 2548-53.
Liu C, Gao J, Liu J, Wang X, et al. Intrahepatic cholestasis of pregnancy is associated with an increased risk of gestational diabetes and preeclampsia. Ann Transl Med 2020; 8: 1574.
Bolukbas FF, Bolukbas C, Balaban HY, et al. Intrahepatic cholestasis of pregnancy: spontaneous vs in vitro fertilization. Euroasian J Hepatogastroenterol 2017; 7: 126-9.
Shan D, Hu Y, Qiu P, et al. Intrahepatic Cholestasis of pregnancy in women with twin pregnancy. Twin Res Hum Genet 2016; 19: 697-707.
Feng C, Li WJ, He RH, Sun XW, Wang G, Wang LQ. Impacts of different methods of conception on the perinatal outcome of intrahepatic cholestasis of pregnancy in twin pregnancies. Sci Rep 2018; 8: 3985.
Çelik S, Çalışkan C. The impact of assisted reproductive technology in twin pregnancies complicated by intrahepatic cholestasis of pregnancy: a retrospective cohort study. Z Geburtshilfe Neonatol 2021; 225: 34-8.
Dokuzeylul Gungor N, Gurbuz T, Yurci A, Demircivi Bor E. Retrospective analysis of spontaneous pregnancy cases after in vitro fertilization six years of experience. JRM 2021; 66: 337-41.
Li L, Chen YH, Yang YY, Cong L. Effect of intrahepatic cholestasis of pregnancy on neonatal birth weight: a meta-analysis. J Clin Res Pediatr Endocrinol 2018; 10: 38-43.