Сравнительный анализ перинатальных исходов при внутрипеченочном холестазе беременных

Abstract

Intrahepatic cholestasis of pregnancy is associated with a higher incidence of adverse neonatal outcomes, including preterm birth, neonatal respiratory distress syndrome, meconium aspiration syndrome (MAS), and stillborn foetuses. Despite the successes achieved in the problem of Intrahepatic cholestasis of pregnant women (ICPW), a significant number of unfavorable outcomes for the mother and the fetus are associated with insufficiently developed possibilities for predicting them. Unsatisfactory results of pregnancy, childbirth and perinatal indicators, which cause a number of medical and social problems, can be reduced with the availability of effective methods for predicting and, if it, successful prevention and treatment of ICPW. Purpose of the study. To study the relationship between clinical and laboratory parameters in pregnant women with ICP W with obstetric and perinatal outcomes. Material and methods. A retrospective analysis of 600 birth histories and exchange cards of pregnant women in the period from 2015 to 2019 with ICPW was carried out, of which 301 pregnant women with intrahepatic cholestasis in the main group, and 299 pregnant women without intrahepatic cholestasis in the control group. Results and discussion. The most frequent complications of pregnancy and childbirth in ICPW were preterm labor, threatening fetal healthcare, preeclampsia, and postpartum hemorrhage. In patients with ICPW, an increase in the level of hepatic transaminases was significantly associated with a high perinatal risk. Respiratory disorders prevailed in the structure of diseases in newborns. An increase in the incidence of unfavorable neonatal outcomes (fetal distress, low Apgar score, low gestational age) is associated with severe hyperenzymemia in severe forms of ICPW. Conclusions. An increase in the level of hepatic transaminases is significantly associated with a high perinatal risk. The isolated use of ultrasound doppler in ICPW does not allow to reliably assess the risk of unfavorable perinatal outcomes. Analysis of the results of ultrasound doppler, with an increase in the level of transaminases, is insufficient to assess the degree of risk of antenatal death or a threatening condition of the fetus. Keywords: Intrahepatic cholestasis, pregnancy, perinatal outcomes.