GEBELİK İNTRAHEPATİK KOLESTAZ OLGULARININ MATERNAL VE NEONATAL SONUÇLARI

Giriş ve amaç: Gebelikte intrahepatik kolestaz (ICP), kaşıntı ve safra asitlerinin yükselmesi ile kendini gösteren, gebelikte sık görülen bir hastalıktır. ICP'nin bazı olumsuz obstetrik sonuçları; Literatürde spontan erken doğum, mekonyumlu amniyotik sıvı, fetal asfiksi ve ölü doğum bildirilmektedir. Tanı, tedavi ve eşlik eden olumsuz sonuçlara ilişkin kanıtların bulunmaması nedeniyle, tedavinin iki ana hedefi vardır: rahatsız edici semptomları ve perinatal morbidite ve mortaliteyi azaltmak. Yöntemler: Ocak 2017 ile Haziran 2021 tarihleri arasında intrahepatik gebelik kolestazı tanısı konularak takip edilen hastaların tıbbi kayıtları geriye dönük olarak incelendi. Bulgular: Hastaların ortalama doğum haftası 38,1±1,4 olup, takipleri sırasında herhangi bir fetal veya neonatal ölüm yaşanmadı. Sonuç: İCP'li hastalarda olumsuz neonatal sonuçlar ve ölü doğum riskinin artması nedeniyle, anne İCP'li hastaların doğum zamanlaması dikkatle değerlendirilmelidir. Sonuç olarak, özellikle ciddi safra asidi yüksekliği olan hastalarda 37. haftada doğumun sonuçları iyileştirebileceğini gösteren bazı kanıtlar vardır. Ancak doğumda ortalama gebelik yaşının 38 hafta olduğu ve fetal mortalitenin görülmediği bu çalışmanın sonucunda, yakın takip ve tedavinin erken uygulanmasıyla 38. haftada doğumun düşük safra asidi düzeyi olan hastalarda sonuçları potansiyel olarak iyileştirebileceğini düşünüyoruz. . Ayrıca, ICP'li hastalarda doğumun optimal zamanlaması, elektif erken doğum indüksiyonunu değerlendiren randomize çalışmaların bulunmaması nedeniyle henüz bilinmemektedir.

Anahtar Kelimeler:

İntrahepatik Kolestaz, Gebelik, Yenidoğan sonuçları, Safra asidi, Ölü Doğum

THE OUTCOME OF MATERNAL AND FETAL CASES WITH INTRAHEPATIC CHOLESTASIS OF PREGNANCY

Introductıon and objektive : Intrahepatic cholestasis (ICP) of pregnancy is a common disorder of pregnancy manifested by pruritus and elevated bile acids.Some negative obstetric outcomes of ICP; Spontaneous preterm birth, meconium amniotic fluid, fetal asphyxia and stillbirth have been reported in the literature. Due to the lack of evidence for diagnosis, treatment, and concomitant adverse outcomes, management has two main goals: reducing troubling symptoms and perinatal morbidity and mortality. Methods: Medical records of patients diagnosed and followed up with intrahepatic pregnancy cholestasis between January 2017 and June 2021 were reviewed retrospectively. Results: The mean week of delivery of the patients was 38.1±1.4, and no fetal or neonatal death occurred during their follow-up. Conclusion: With respect to the increased risk of adverse neonatal outcomes and stillbirth in patients with ICP, timing of birth in maternal ICP patients should be carefully evaluated. In conclusion, there is some evidence to suggest that birth at 37th weeks, especially in patients with severe bile acid level elevations, may improve outcomes. However as a result of this study in which the average gestational age at birth was 38 weeks and no fetal mortality occurred, we suggest that with close monitoring and early administration of treatment birth at 38 weeks could potentially improve outcomes in patients with low bile acid levels. Furthermore, optimal timing for birth in patients with ICP is as of yet unknown, due to the absence of randomized studies evaluating elective early induction of labor.

Keywords:

Intrahepatic Cholestasis, Pregnancy, Neonatal outcomes, Bile acid, Stillbirth,

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