Analysis Of Pregnancy Outcomes And Diagnosis Of Early-onset Intrahepatic Cholestasis Of Pregnancy

Objective:To analyse the biochemical characteristics and perinatal outcomes of the patients for different gestational weeks of intrahepatic cholestasis of pregnancy, to provide clinical basis for diagnosis and treatment for early-onset intrahepatic cholestasis of pregnancy.Methods:From July 2013 to June 2015,482 ICP patients with singleton pregnancy were selected in Women’s Hospital School of Medicine Zhejiang University. According to the onset time of ICP, patients were divided into group A:gestational age of onset< 28 weeks group (n= 95); group B:28 weeks<gestational age of onset< 32 weeks (n= 70); group C:gestational age of onset≥ 32 weeks (n=317). Among them, patients whose gestational age of onset< 32 weeks were divided into early-onset ICP group, the others were in late-onset ICP group. The serum biochemical indices and the perinatal outcomes in each group were analysed retrospectively.Results:(1) Compare the age, height, weight and BMI of group A,B,C, the differences were not statistically significant (P> 0.05). (2) The maternal serum concentrations of total bile acid (TBA) and cholylglycine (CG) level in group A were the highest, group B took second place, and group C were the lowest, and the differences were statistically significant (P< 0.05); The alkaline phosphatase (ALP) in group A was the lowest, group B took second place, and group C was the highest, and the difference was statistically significant (P< 0.05); However, the alanine aminotransferase (ALT) and aspartate transaminase (AST) level of the three groups didn’t increased or decreased as the onset of gestational age increased. (3) The proportion of severe ICP of group A was the highest, group B was a little lower, and group C was the lowest, the difference was statistically significant (P<0.05); There were no significant differences in the incidence of preterm birth, the gestational weeks at delivery, the birth weight and the neonatal respiratory system dysfunction rate (P>0.05), but the difference between group B and group C was statistically significant (P<0.05); Compare the mode of delivery, amniotic fluid and fetal distress rate of the three groups, there were no statistically significant difference (P>0.05); (4) The maternal serum concentration of TBA and CG of early-onset ICP group (gestational age of onset<32 weeks) were significantly higher than that of late-onset ICP group (P<0.05); The proportion of severe ICP, the cesarean delivery rate, the premature delivery rate and the neonatal respiratory system dysfunction rate in early-onset ICP group were significantly higher than those in late-onset ICP group (P<0.05); The average gestational weeks at delivery and the birth weight of early-onset ICP group were significantly lower than those of late-onset ICP group (P<0.05); The incidence of meconium-staining amniotic fluid and fetal distress between early-onset and late-onset ICP groups had no significant differences (P>0.05); (5) The preterm delivery rate, cesarean delivery rate and the incidence of neonatal respiratory system dysfunction of severe early-onset ICP group were significantly higher than those of the mild early-onset ICP group (P<0.05); Severe early-onset ICP patients had significantly lower gestational weeks at delivery and birth weight than mild early-onset ICP patients (P<0.05); The incidence of meconium-staining amniotic fluid and fetal distress between severe and mild early-onset ICP groups had no significant differences (P>0.05).Conclusion:The perinatal outcomes of ICP patients whose gestational age of onset <32 weeks were significantly worse than those happened ≥ 32 weeks. Therefore, made the onset gestational age of early-onset ICP at 32 weeks may be more appropriate. The early-onset ICP patients had worse perinatal outcomes than late-onset ICP patients, so more attention should be paid by the clinicians. The obstetricians should make appropriate termination of pregnancy, in order to improve the perinatal outcomes.