2024-03-28T13:34:18Zhttps://gredos.usal.es/oai/requestoai:gredos.usal.es:10366/1407122022-02-10T10:15:18Zcom_10366_3992com_10366_3947com_10366_3946com_10366_3823col_10366_3993
00925njm 22002777a 4500
dc
Estiú, María Cecilia
author
Frailuna, Maria A.
author
Otero, Carla
author
Dericco, Marcela
author
Williamson, Catherine
author
Marin, Jose J. G.
author
Rodríguez Macías, Rocío Isabel
author
2017-04-24
[EN] Background
Intrahepatic cholestasis of pregnancy (ICP) is the commonest gestational liver disease. The risk of adverse fetal outcome has been associated with the severity of maternal hypercholanemia after diagnosis.
Objective
To investigate whether there is a relationship between the severity and timing of onset of hypercholanemia and the risk of meconium-stained amniotic fluid (MSAF) and adverse neonatal events.
Study design
The study included 382 pregnancies complicated by ICP managed at a referral hospital in Buenos Aires (Argentina) between June 2009 and December 2013. The patients were classified into three groups according to the severity of hypercholanemia at diagnosis; mild (10–19.9 μmol/L), moderate (20–39.9 μmol/L) and severe (≥40 μmol/L). Their clinical characteristics and pregnancy outcomes were investigated in a prospective observational study.
Results
Higher risk of MSAF was observed when ICP appeared early in gestation or when hypercholanemia was more severe. Taking both parameters into account an MSAF risk factor (MRF) was defined. Based on a model of positive/negative predictive values, a cut-off point of MRF = 3 was selected, which prioritized sensitivity versus specificity. In ICP patients with MRF>3, the probability of MSAF was enhanced 4-fold. An increase in the frequency of MSAF was also associated with higher serum levels at diagnosis of alanine transaminase, alkaline phosphatase and direct bilirubin.
Conclusions
The risk of MSAF is associated not only with the magnitude of hypercholanemia at diagnosis but also with the early gestational onset of raised maternal serum bile acids.
Estiú, M.,C., Frailuna, M. A., Otero, C., Dericco, M., Williamson, C., Marin, J. J. G., & Macias, R. I. R. (2017). Relationship between early onset severe intrahepatic cholestasis of pregnancy and higher risk of meconium-stained fluid. PLoS One, 12(4) doi:http://dx.doi.org/10.1371/journal.pone.0176504
http://hdl.handle.net/10366/140712
10.1371/journal.pone.0176504
1932-6203
Intrahepatic cholestasis of pregnancy (ICP)
Pregnancy
gestational liver disease
MSAF
Relationship between early onset severe intrahepatic cholestasis of pregnancy and higher risk of meconium-stained fluid