Clinical Analysis Of Recurrent Intrahepatic Cholestasis Of Pregnancy

Objective:To analyse the clinical characteristics and perinatal outcomes of the patients for the recurrent intrahepatic cholestasis of pregnancy,to provide clinical basis for management of recurrent intrahepatic cholestasis of pregnancy.Methods:From January 2005 to December 2017,204 ICP patients with singleton pregnancy who delivered twice in our hospital and had at least one ICP occurred were selected in Women’s Hospital School of Medicine Zhejiang University.Comparing the first and second pregnancies of recurrent ICP(N=75),the first-episode and non-recurrent ICP(N=23)and the first pregnancy of recurrent ICP;recurrent ICP and first-episode in her second pregnancy(N=106),mild recurrent ICP and severe recurrent ICP.The serum biochemical indices,onset of gestational weeks and the perinatal outcomes in each group were analysed retrospectively.Results:(1)The first and second pregnancies of recurrent ICP:The onset of gestational age was significantly earlier at the time of ICP recurrence,and the proportion of early-onset ICP was higher than that of the previous episode(P<0.05);proportion of severe ICP,serum total bile acids,ALT,AST,and ALP have no significant difference(P>0.05);Termination of gestational age,cesarean section rate,fetal birth weight,meconium—staining amniotic fluid,fetal distress,premature rupture of membranes,neonatal respiratory disease,and newborn pediatric occupancy rate were not statistically significant(P>0.05);(2)Recurrent ICP and first-episode in her second pregnancy:The onset week of recurrent ICP is earlier,the proportion of early-onset ICP and severe ICP was significantly higher than first-episode in the second pregnancy,and there was a significant difference(P<0.05);TBA and CG in recurrent ICP were higher in patients with ICP than those first-episode in the second pregnancy(P<0.05).There was no statistically significant difference between ALT and AST;there was a statistically significant difference in gestational age,fetal birth weight,cesarean section rate,neonatal respiratory disease,premature birth rate,and newborn pediatric occupancy rate have statistical difference(P<0.05).There was no statistical difference in fetal distress,premature rupture of membranes,meconium—staining amniotic fluid(P>0.05);(3)The first-episode and non-recurrent ICP(N=23)and the first pregnancy of recurrent ICP:The onset of gestational weeks in the first pregnancy of recurrent ICP group was earlier than that in the non-recurrent ICP group,and the proportion of early-onset ICP and severe ICP was higher(P<0.05),but TBA,CG,ALT and AS have no significant difference(P>0.05);there was statistical difference in gestational age at delivery(P<0.05);but the cesarean section rate,fetal birth weight,meconium—staining amniotic fluid,fetal distress,premature rupture of membranes,neonatal respiration There was no significant difference in systemic disease and newborn pediatric occupancy rate(P>0.05);(4)Mild and severe recurrent ICP:Compared with mild recurrent ICP group,the proportion of early-onset ICP was higher in severe recurrent ICP(P<0.05).Birth weight,gestational age at delivery were lower than that of mild recurrent ICP,newborn pediatric occupancy rate,the incidence rate of neonatal respiratory system abnormalities was higher than that of mild recurrent ICP group.There was no significant difference in cesarean section rate,meconium—staining amniotic fluid,fetal distress,and premature rupture of membranes(P>0.05).Conclusion:In patients with ICP,the recurrence rate is high in next pregnancy,and the recurrent rate of early-onset ICP and severe ICP is higher.Recurrent ICP is onset in an earlier gestational age,the condition is heavier,and the pregnancy outcome is worse.Therefore,for patients with ICP,we must vigilant for recurrence.Routine serum levels of TBA,CG,and liver function should be measured during the first trimester.Once diagnosed,monitoring during pregnancy should be strengthened and termination of pregnancy if necessary.