Ayla Sargın ORUÇ, Şevki ÇELEN, Nuri DANIŞMAN

Gebeliğin intrahepatik kolestazı: Etiyopatogenez, maternal ve fetal etkileri

Gebeliğin intrahepatik kolestazı (GİK); gebeliğin ikinci yarı-sında kaşıntı ve yüksek serum safra asiti konsantras-yonları ile karakterize ve ciddi fetal riskler taşıyan, gebeliğe özgü bir karaciğer fonksiyon bozukluğudur. Maternal etkiler hafif olmakla birlikte GİK‘de fetal distres, preterm doğum ve ani intrauterin ölüm sıklığında bir artış izlenmektedir. Etiyolojisi tam olarak bilinmemek-tedir ancak genetik olarak duyarlı kadınlarda reprodüktif hormonlar ve metabolitlerinin kolestatik etkilerinden kaynaklandığı düşünülmektedir. Aynı şekilde fetal komp-likasyonların da ne şekilde oluştuğu henüz net olarak anlaşılmış değildir. Farmakolojik tedavide en etkin ajan ursodeoksikolik asittir, ancak obstetrik komplikasyonların yönetiminde halen nasıl bir yol izlenmesi gerektiği açık-lığa kavuşturulamamıştır. Bu derlemede Gebeliğin intra-hepatik kolestazının epidemiyolojisi, klinik özellikleri, etiyolojisi, tanı, tedavi ve obstetrik yönetimi gözden geçirilmiştir.

Anahtar Kelimeler:

Epidemiyoloji, Safra asitleri ve tuzları, Kolestaz, intrahepatik, Gebelik komplikasyonları

Intrahepatic cholestasis of pregnancy: Etiopatho-genesis, maternal and fetal impacts

Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy specific liver disorder characterized by maternal pruritus in the latter half of the pregnancy, raised serum bile acids and increased rates of adverse fetal outcomes. Maternal effects of ICP are mild; however, there is a clear association between ICP and higher frequency of fetal distress, preterm delivery, and sudden intrauterin fetal death. The etiology of ICP is elusive but it is likely to result from the cholestatic effects of reproductive hormones and their metabolites in genetically susceptible women. The mechanisms by which fetal complications occur is also unclear. Ursodeoxycholic acid is currently the most effective treatment, but obstetric management is stil debated. In this article we tried to review epidemiology, clinical features, etiology, diagnosis, pharmacologic treatment and obstetric management of ICP.

Keywords:

Epidemiology, Bile Acids and Salts, Cholestasis, Intrahepatic, Pregnancy Complications,

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