Hilal USLU YUVACI, Mehmet Musa ASLAN, Merve KESKİN PAKER, Selçuk ÖZDEN

Gebeliğin İntrahepatik Kolestazı ve Gebelik Sonuçlarının Değerlendirilmesi

Amaç: Gebeliğin intrahepatik kolestazı(GİK) spontan preterm doğum, fetal distress, mekonyum boyalı amnion sıvısı ve ölü doğum gibi obstetrik komplikasyonlara yol açabilen, gebeliğe spefisik en sık görülen hepatik hastalıktır. Bu çalışmada GİK tanısı konulan hastaların gebelik ve fetal sonuçlarının retrospektif olarak değerlendirilmesi amaçlandı.Materyal Metot: Retrospektif olgu çalışmasında Kasım 2017-Eylül 2019 tarihleri arasında kaşıntı şikayeti ile başvuran, herhangi bir karaciğer ve cilt patolojisi yokken devamlı kaşıntı ve maternal kanda artmış safra asitleri (≥10 μmol/L) bulunan gebeler GİK olarak kabul edildi. Çalışmaya dahil edilen 44 olgunun demografik özellikleri, karaciğer enzimleri, tanı aldığı gebelik haftası, hastalığa maruz kalınan süre, doğum şekli, doğum zamanı, doğumda APGAR skoru ve yenidoğanın kilosu bilgileri hastane kayıtlarından alındı. Bulgular: Olguların yaş ortalaması 26,77 ± 6,23, %61,4’ ü nullipar gebe idi. Ortalama tanı alma zamanı 35,52±1,72 hafta, doğum haftası 36,64± 1,78 hafta bulundu. Hastalığa maruz kalınan süre 7,54 ± 8,14 gün olarak hesaplandı. Gebelerin 17’ si (% 38,6) normal vajinal yolla, 27’ si (%61,4) sezaryen ile doğurdu. Gebelik komplikasyonları, preterm doğum (n=1), gestasyonel diyabet (n=1) ve preeklampsi (n=1) olarak bulundu. İnutero fetal ölüm gerçekleşmedi. Sonuç: Gebeliğin intrahepatik kolestazı önemli maternal ve fetal komplikasyonlara neden olur. Bu komplikasyonların önlenmesinde yakın takip ve aktif yönetim gereklidir.

Anahtar Kelimeler:

Gebelik, intrahepatik kolestaz, komplikasyon, neonatal sonuç

Intrahepatic Cholestasis of Pregnancy and Evaluation of Obstetric Outcomes

Aim: Intrahepatic cholestasis of pregnancy(ICP) is the most frequently encountered pregnancy-specific hepatic disease that may cause obstetric complications such as spontaneous preterm birth, fetal distress, meconium-stained amnion fluid and stillbirth. This study aimed to retrospectively analyze the pregnancy and fetal outcomes of patients who were diagnosed with ICP.Material and Method: In the retrospective case study, pregnant women who visited with the complaint of itching between November 2017 and September 2019 and had constant itching and increased bile acids in the maternal blood (≥10 μmol/L) without any liver or skin pathology were accepted as ICP. For the 44 cases that were included in the study, demographic characteristics, liver enzymes, week of pregnancy at diagnosis, duration of exposure to the disease, type of delivery, time of delivery, APGAR scores and the weight of the newborn were collected from the hospital records. Results: The mean age of the participants was 26,77±6,23, while 61,4% were nulliparous. The mean time of diagnosis was 35,52±1,72 weeks, while the mean week of pregnancy was 36,64±1,78. The mean duration of exposure to the disease was calculated as 7,54±8,14 days. 17 of the pregnant women (38,6%) gave birth via normal vaginal delivery, while 27 (61,4%) gave birth by Cesarean section delivery. Pregnancy complications were found as preterm birth (n=1), gestational diabetes (n=1) and preeclampsia (n=1). There was no in utero fetal death. Conclusion: Intrahepatic cholestasis of pregnancy causes significant maternal and fetal complications. Close monitoring and active management are required in prevention of these complications.

Keywords:

Pregnancy, Intrahepatic Cholestasis, Complication, Neonatal Outcomes,

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