[Show abstract][Hide abstract]ABSTRACT: To study the clinical features and diagnosis of intrahepatic cholestasis of pregnancy (ICP).
During the last 10 years 1241 cases of ICP stayed in our hospital. Their clinical data were retrospectively reviewed.
5.2% of all the maternity patients had ICP. It occurred more in winter and 3.5% of ICP occurred in multiple pregnancies. The recurrence rate of ICP was 30.2%. On the average, it occurred at gestational week 32.6. Skin pruritus was the characteristic manifestation and the presenting symptom in 1201 patients (96.8%). The other presenting features included elevated serum ALT and AST (2.3%), jaundice (8 patients), diarrhea (3 patients), deep yellow urine (2 patients) and right upper abdominal pain (1 patient). The serum transaminases levels were elevated, of which 60% were between 50-200 IU/L. Serum total bile acid (TBA) levels were elevated in 82.4% of the patients and bilirubin levels in 33.4%. The elevated bilirubin levels were 30 to 90 micromol/L in 85% of those patients with this condition, and it was never higher than 170 micromol/L.
The basic diagnostic points of ICP are pruritus and abnormal liver function characterized by increased transaminases and TBA. Therefore paying attention to typical pruritus and other atypical features such as elevated serum transaminases, jaundice, diarrhea, deep yellow urine and right upper abdominal pain during antenatal care is important for an early diagnosis of ICP.
No preview · Article · May 2007 · Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology
[Show abstract][Hide abstract]ABSTRACT: To study the perinatal outcomes of intrahepatic cholestasis of pregnancy (ICP).
The clinical data of 1210 cases of ICP in recent ten years were retrospectively analyzed.
The incidence rates of perinatal outcomes of ICP were as follows: 19.0% (230/1210) for threatened premature labor, 24.0% (290/1210) for premature delivery; 23.2% (281/1210) for meconium stained amniotic fluid, 7.1% (86/1210) for neonatal asphyxia, 22.5 per thousand (27/1210) for perinatal mortality, 85.9% (1039/1210) for cesarean section, 0.9% (11/1210) for fetal growth restriction (FGR), 1.4% (17/1210) for postpartum hemorrhage, and 8.1% (101/1210) for preeclampsia. Threatened premature labor occurred beyond the gestation gestation period of 32 weeks in 88.7% (204/230) of the patients, and the fetal death rate in threatened premature labor was 46.7% (7/15). Premature delivery occurred after 34 weeks of gestation in 96.2% of the patients (279/290) 89.7% (260/290) of which were caused by cesarean section because of abnormal fetal monitoring. 41.3% of the cases with meconium stained amniotic fluid (116/281) occurred before the onset of labor. Fetal death accounted for 56% (15/27) of perinatal death, 80% (12/15) of which happened after the gestation week of 35 (36.5 +/- 1.2) with normal fetal heart rate monitoring. 95% (19/20) of the fetal death and stillbirth occurred after threatened premature labor and occasional uterine contractions, or at the early stage of labor.
The rates of FGR, postpartum hemorrhage, and preeclampsia in ICP are almost the same as those of the normal pregnancy. Routine fetal heart rate monitoring methods cannot predict fetal death. The important measures to decrease the perinatal mortality include paying attention to fetal monitoring when threatened premature labor, occasional uterine contractions and prenatal meconium occur, and at the early stage of labor, and management of threatened premature labor and timely intervention of pregnancy (at the gestation period of 34 - 37 weeks).
No preview · Article · Mar 2006 · Zhonghua yi xue za zhi
[Show abstract][Hide abstract]ABSTRACT: To investigate the influence of transforming growth factor-beta2 (TGF-beta2) on production of tumor necrosis factor-alpha (TNF-alpha) and interferon-gamma (IFN-gamma) from placenta of patients with intrahepatic cholestasis of pregnancy (ICP).
Villous explants from 10 ICP patients (ICP group) and 10 normal gravidae (control group) were cultured in vitro. The concentrations of TNF-alpha and IFN-gamma in the culture medium were determined by enzyme linked immunoadsorbent assay (ELISA) after incubation with different concentrations of TGF-beta2 for 1, 24 and 48 hours.
(1) After cultured for 1, 24 and 48 hours, TNF-alpha level in ICP group was (771 +/- 187) pg/g, (2 490 +/- 575) pg/g, and (3339 +/- 1106) pg/g, respectively, while IFN-gamma level was (931 +/- 148) pg/g, (1888 +/- 545) pg/g, and (3027 +/- 667) pg/g, respectively. All were significantly higher than those in the normal group (P < 0.001). (2) TGF-beta2 could inhibit the release of above cytokines in a time- and dose-dependent manner: TNF-alpha level was (2490 +/- 575) pg/g, (1806 +/- 502) pg/g, and (1231 +/- 238) pg/g after 24 h, (3339 +/- 1106) pg/g, (2168 +/- 794) pg/g, and (1047 +/- 183) pg/g after 48 h, respectively; IFN-gamma level was (1888 +/- 545) pg/g, (1 347 +/- 405) pg/g, and (913 +/- 303) pg/g after 24 h, and (3027 +/- 667) pg/g, (2062 +/- 795) pg/g, and (1001 +/- 301) pg/g after 48 h, respectively.
(1) The excessive production of TH1 type cytokines TNF-alpha and IFN-gamma may involve in the pathogenesis of ICP; (2) TGF-beta2 may exert immunoprotection effect through inhibiting the production of TNF-alpha and IFN-gamma.
No preview · Article · May 2004 · Zhonghua fu chan ke za zhi
[Show abstract][Hide abstract]ABSTRACT: To investigate the clinical characteristics of intrahepatic cholestasis of pregnancy (ICP).
Totally 1241 cases of ICP during the 10 years from Jan 1991 to Dec 2000 in our hospital were retrospectively reviewed.
Forty-four (3.5%) patients were multiple gestation. One hundred and one (8.1%) patients had pregnancy induced hypertension. ICP recurred in 30.2% multipara (38/126). On average, it occurred at gestational week of 32.6. Pruritus was the first symptom in 1201 (96.8%) patients while 8 (0.6%) patients had jaundice and 28 (2.3%) patients had abnormal liver function at the onset. Serum total bile acid (TBA), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were usually mild or moderately elevated, while some patients had normal TBA (17.7%), ALT (15.6%), or AST (17.1%) level. The albumin/globulin ratio was reversed in 35 (3.2%) patients.
ICP tends to recur in subsequent pregnancy. It is more likely to develop in multiple gestation. Pruritus is the most common and prominent manifestation. Elevated TBA and ALT or AST level is helpful for diagnosis. It should be noted that the above manifestations might not be typical in some patients.
No preview · Article · May 2004 · Zhonghua fu chan ke za zhi