Mehmet Ferdi KINCI, Özge ŞEHİRLİ KİNCİ, Ezgi KARATAŞ

Gebeliğin İntrahepatik Kolestazı

Gebeliğin intrahepatik kolestazı (GİK); gebeliğin 2. Trimestr’ından sonra gelişen, karakteristik olarak serum safra asidi yüksekliği ve kaşıntı ile seyreden gebeliğe özgü bir karaciğer hastalığıdır. Prevelansı; etnik köken, genetik ve çevresel faktörlere bağlı değişkenlik göstermekle birlikte ülkemizdeki sıklığı %0.45 olarak bildirilmiştir. Genetik faktörlerden özellikle hepatositlerde fosfolipid transportunda görevli ABCB4 geni üzerinde durulmaktadır. Risk faktörleri arasında geçirilmiş GİK öyküsü, ileri maternal yaş (>35), multiparite, oral kontraseptif kullanımı ile birliktelik gösteren kolestaz öyküsü, yardımcı üreme teknikleri ile gebe kalmak, ovaryan hiperstimulasyon sendromu, çoğul gebelik, kronik Hepatit C hastası olmak yer almaktadır. En sık semptomu kaşıntıdır ve genelikle avuç içi ve ayak tabanında izlenir. Serum safra asidi yüksekliği (>10 µmol/L) etkilenen gebelerin %90’ında görülür. Serum aminotransferazları hastaların %60’ında artış göstermektedir. Bu artış çoğunlukla normalin 2 katını geçmemektedir. GİK olan hastalarda intrauterin fetal kayıp, mekonyumlu amnion mayi, spontan ve iatrojenik preterm doğum, yenidoğan yoğun bakım ihtiyacı artmış olarak izlenmiştir. Bu komplikasyonlardan fetal dolaşımda artan safra asidi sorumlu tutulmaktadır. Tedavinin amacı maternal biyokimyasal değerlerin normal referans aralığı yakın tutulması, maternal kaşıntı başta olmak üzere semptomların azaltılması ve fetal komplikasyonların önlenmesidir. Ursodeoksikolik asit (UDCA) diğer yöntemlerle karşılaştırıldığında serum safra asidi düzeylerinde ve karaciğer enzimlerinde daha belirgin düzelme sağlamaktadır. İntrauterin fetal kayıp GİK’te ani olarak gelişmekte ve bu nedenle NST, USG ve doppler USG değerlendirmelerinin takipteki yeri sınırlıdır. Gebelerin hangi sıklıkta izleneceği konusunda bir fikir birliği yoktur. Preterm doğum beklenen hastalarda akciğer matürasyonu için kortikosteroid önerilmektedir. GİK olan hastalarda fetal mortalitenin 36. haftada doğumu gerçekleştirilenlerde daha düşük olduğu bildirilmiştir.

Anahtar Kelimeler:

Kolestaz, Safra Asitleri, Ursodeoksikolik Asit

Intrahepatic Cholestasis of Pregnancy

Intrahepatic cholestasis of pregnancy; is a pregnancy-specific liver disorder developing after the second trimester of pregnancy, characteristically coursing with high serum bile acid level and maternal pruritus. Its prevalence shows a chance depending on environmental factors, genetics and ethnic origin and at the same time it is reported that the frequency of this disease is 0.45% in our country. In all genetic factors, especially ABCB4 gene, which is in charge with transporting phospholipid in hepatocytes is dwelled on. Risk factors include previous presence of NCBI, advanced maternal age (˃35), multiparity, history of cholestasis with the use of oral contraceptive, becoming pregnant with assisted reproductive techniques, ovarian hyperstimulation syndrome, multiple pregnancy, being a patient with chronic hepatitis C. The most frequent symptom is pruritus and it is generally seen on palm and soles. It is seen among 90% of pregnant impressed by the high level of serum bile acid (˃10 umol/L). Serum aminotransferases show increase among 60% of the patients. This increase generally isn’t two times more than normal. Intrauterine fetal loss among the patients with NCBI, is seen as amnion liquid with meconium, spontaneous and iatrogenic preterm birth, increased need in neonatal intensive care. Bile acid increasing in fetal circulation is hold responsible for these complications. The aim of the cure is to keep the maternal biochemical values close to the normal reference range, decrease the symptoms; especially maternal pruritus, prevent fetal complications. When it is compared with the other methods, ursodeoxycholic acid (UDCA) provides more apparent improvement in the liver enzymes and the levels of serum bile acid. Intrauterine fetal loss with NCBI occurs suddenly so NST, USG and doppler USG evaluations are limited in the place of follow up. There isn’t a consensus on how often a pregnant should be screening. Among the patients who are expected to have preterm birth, corticosteroid is suggested for lung maturation. It is stated that fetal mortality is lower among the patients with NCBI than who gives birth at the 36th week.

Keywords:

Cholestasis, Bile Acid, Ursodeoxycholic Acid,

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