Abstract
Aim: To determine the relationship between increased serum bile acid concentrations and the first stage of labor in multiparous women induced by vaginal prostaglandin E2 (PGE2) with intrahepatic cholestasis of pregnancy (ICP). Material and Methods: In this retrospective case-control study 283 multiparous women with ICP and 283 healthy multiparous pregnant women were admitted for induction of delivery, were inserted PGE2 (10 mg dinoprostone) vaginally. The groups with mild, moderate and severe ICP were compared with control group in terms of the time from beginning of PGE2 vaginal insertion to active phase of labor, the time from beginning of PGE2 vaginal insertion to complete dilatation of cervix and fetal outcomes. Results: The time from beginning of PGE2 insertion to active phase in the mild, moderate and severe ICP groups were shorter than in the non-ICP group; 3.19±0.32, 7.26±0.34, 8.71±0.35 hours, respectively (p<0.01). The time from beginning of PGE2 insertion to complete dilatation of cervix in the groups with mild, moderate and severe ICP were shorter than in non-ICP group; 3.03 ± 0.45; 10.33 ± 0.62; 14.44 ± 0.53, respectively (p<0.01). There was no difference between the groups in terms of fetal outcomes except fetal weight and the presence of meconium (p<0.01). Conclusion: Increased bile acid concentrations in multiparous pregnant women induced by vaginal PGE2 with mild, moderate and severe ICP are associated with shorter duration of cervical ripening and labor induction time to delivery. The study concluded that multiparous women with ICP can deliver faster as the severity of cholestasis increases.
Highlights
Intrahepatic cholestasis of pregnancy (ICP) is a liver disorder characterized by an increase in serum bile concentrations (≥10 mmol/L) in the third trimester with itching, and recovers rapidly during the postnatal period, but may recur in subsequent pregnancies [1]
The aim of this study was to show how increased severity of ICP affected the time from beginning of prostaglandin E2 (PGE2) vaginal insertion to active phase of labor, the time from beginning of PGE2 vaginal insertion to complete dilatation of cervix, the need for oxytocin induction, and neonatal outcomes in multiparous women induced by vaginal PGE2 with ICP
The presence of meconium in amnion in the groups was correlated with increased levels of ICP (p
Summary
Intrahepatic cholestasis of pregnancy (ICP) is a liver disorder characterized by an increase in serum bile concentrations (≥10 mmol/L) in the third trimester with itching, and recovers rapidly during the postnatal period, but may recur in subsequent pregnancies [1]. It occurs with an incidence of 0.3-5.6% of all pregnancies [2]. In 1.2% of pregnancies, women who still have ICP after the 37th gestational week may experience sudden intrauterine fetal loss and the risk increases proportionally as the gestational week and bile acid concentrations increase [5]. Bile acids increase fetal bowel movements and may cause amniotic staining with meconium [8]
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