ABC of OC=Obstetric Cholestasis :Intrahepatic Cholestasis of pregnancy (ICP) is a pregnancy-associated liver disease. It is the most common liver disease in pregnant women, with incidence figures of 0.1-1.5%
ICP is a reversible illness that is characterized by pruritus, predominantly on the palms and soles, in the second or third trimester, combined with elevated serum bile acid (BA) levels (>- 10 u mol/L). Usually, there are also abnormal trans aminase levels. Symptoms and laboratory abnormalities disappear spontaneously after delivery.
ICP is a relatively nonthreatening condition to women but is associated with fetal complications. It is linked with a higher risk of preterm delivery, meconium passage, fetal distress, and fetal death. The underlying mechanisms of these complications are unknown. First, research in animals has shown a detrimental effect of high BA levels on cardio myocytes, which cause arrhythmia. If these potentially lethal arrhythmia also occur in the fetus, it possibly could explain the incidence of stillbirth. Second, a vasoconstrictive effect of BA on placental chorionic veins has been shown, possibly explaining the occurrence of fetal distress, asphyxia and death. Finally, several studies have shown BA to increase the sensitivity and expression of oxytocin Receptors in the human myometrium, possibly clarifying the mechanism behind spontaneous preterm labor in pregnancies that are complicated by ICP. The diagnosis of ICP is based on the presence of pruritus in combination with elevated BA levels. Although specific predictors for poor fetal outcome have not been identified consistently, higher BA levels (especially those>40 uml/L) were found to be associated with higher rates of fetal complication. Maternal treatment with ursodeoxycholic acid has been proved to provide significant relief of symptoms, to reduce serum BA levels, and to prolong pregnancy duration. However, it has not been documented to improve fetal outcome. The aim of this study was to investigate the association between BA levels and adverse pregnancy outcome. In addition, the relationship between fetal and maternal BA levels at the time of delivery was investigated.
ICP shown a significantly increased risk for iatrogenic preterm delivery, spontaneous preterm delivery, meconium-stained amniotic fluid, postpartum hemorrhage, and sudden intrauterine death, when ICP is sever (>-100 umol/L). this confirms the results of recent large study from the United Kingdom.
ICP is associated with spontaneous preterm delivery, meconium-staining of amniotic fluid, postpartum hemorrhage and perinatal death. In severe cases of ICP, sudden and unprejudiced intrauterine death is seen. A
more aggressive approach of elective delivery may be justified when BA levels are >100 u ml/L. levels of Bile acids as correlate between mother and fetus and imply a causal relationship between level of BA and fetal complications and adverse outcome.
Like
Co
No comments:
Post a Comment