| Objective:To analyze the pregnancy situation,serum biochemical indexes and maternal and fetal outcomes of patients with intrahepatic cholestasis of pregnancy(ICP)and normal pregnant women,so as to provide reference for clinical management of patients with ICP.Methods:The clinical data of 77 ICP patients(study group)admitted to the First Affiliated Hospital of Kunming Medical University from January 1,2017 to January 1,2022 were collected,and 77 normal pregnancy patients were randomly selected as the control group.ICP patients with onset gestational age < 34 weeks in the study group were divided into group A(39 cases),ICP patients with onset gestational age ≥ 34 weeks were divided into group B(38 cases);According to the results of B-ultrasound,ICP patients who underwent hepatobiliary B-ultrasound during pregnancy in the study group were divided into normal B-ultrasound group(25 cases)and abnormal B-ultrasound group(30 cases).The following items are included in clinical data:(1)General information: delivery age,nationality,education,pre-pregnancy weight,weight gain during pregnancy,pre-pregnancy body mass index(BMI),in vitro fertilization(IVF),pregnancy history,scar uterus,prenatal examination,previous history of adverse pregnancy,hospitalization days,pregnancy complications,planned pregnancy,neonatal gender,etc.(2)ICP patients ’gestational age of onset,gestational age of diagnosis,onset season,abdominal B-ultrasound during pregnancy,initial symptoms,causes of admission,previous pregnancy history of ICP,treatment.(3)Serum biochemical indicators : blood cell analysis,liver function,coagulation function,etc.;(4)Maternal and neonatal outcomes : mode of delivery,premature rupture of membranes,postpartum hemorrhage,neonatal birth weight,head circumference,body length,premature delivery,neonatal Apgar score,intrauterine distress,amniotic fluid meconium contamination,neonatal intensive care unit(NICU),etc.Analyze the above data to explore the clinical characteristics and pregnancy outcomes of ICP patients with different onset gesta tional weeks,analyze the significance of hepatobiliary B-ultrasound examination during pregnancy in judging the severity of ICP patients and the prognosis of perinatal infants,and compare ICP patients with different onset gestational weeks and normal pregnant women.Differences in pregnancy conditions,pregnancy complications,serum biochemical indicators,and maternal and fetal outcomes.Results:(1)General situation : the weight gain of ICP patients during pregnancy was lower than that of normal pregnant women,the rate of advanced maternal age and hospitalization days were higher than those of normal pregnant women,and the incidence of gestational diabetes mellitus(GDM)in ICP patients was higher than that of normal pregnant women(P<0.05);There was no significant difference in pregnancy order,parity,pre-pregnancy weight,pre-pregnancy BMI,nationality,education between ICP patients and normal pregnant women(P > 0.05).the onset gestational age and confirmed gestational age of group B were higher than those of group A,the untreated rate of group A was lower than that of group B,and the hospitalization rate of group A was higher than that of group B(P<0.05).There was no significant difference in ICP,initial symptoms,reasons for admission,treatment,use of vitamin K1 before delivery,or ICP grading between groups A and B(P>0.05).(2)the onset season of ICP patients and hepatobiliary B-ultrasound of ICP patients: 77 ICP patients have the highest incidence in summer,autumn,and winter,with the lowest incidence in spring.There were 55 cases(71.43 %)of 77 patients with ICP who underwent hepatobiliary B-ultrasound during pregnancy.Among them,25 cases had no abnormalities in hepatobiliary B-ultrasound.There were 30 patients with abnormal results in B-ultrasound,but there was no characteristic change in B-ultrasound results.(3)The bile acid concentration and the incidence of severe ICP in the abnormal group of hepatobiliary B-ultrasound were higher than those in the normal group of hepatobiliary B-ultrasound,and the amniotic fluid meconium contamination rate and NICU transfer rate were higher than those in the normal group of hepatobiliary B-ultrasound,the differences were statistically significant(P <0.05).(4)Serum biochemical indexes : the white blood cell count and neutrophil count in group A were higher than those in control group,and the mean platelet volume in group B was higher than that in group A and control group(P < 0.05),There was no significant difference in lymphocyte count,platelet/lymphocyte ratio,neutrophil/lymphocyte ratio,or average red blood cell distribution width between the three groups(P > 0.05);the fibrinogen level in the ICP group was higher than that in the control group(5.77 ± 1.09 g / L VS 4.40 ± 0.76 g / L,5.02 ± 0.78 g / L VS 4.40 ±0.76 g / L).The fibrinogen level in group A was higher than that in group B,and the difference was statistically significant(P < 0.05).Compared with the control group,the PT of group B was shortened(11.80 seconds VS 12.30 seconds)(P < 0.05).The concentration of bile acid in group A(47.70 umol / L)and group B(35.00 umol / L)was higher than that in control group(2.00 umol / L)(P<0.05).AST and ALT in group A and group B were significantly higher than those in control group(37.30 IU /L VS 15.90 IU / L,118.85 IU / L VS 15.90 IU / L).AST and ALT in group A were significantly lower than those in group B(P < 0.05).TBIL in group A and group B was significantly higher than that in control group(9.00 umol / L VS 5.70 umol / L,14.00 umol / L VS 5.70 umol / L)(P < 0.05);the DBIL of group A and group B was significantly higher than that of control group(4.50 umol / L VS 2.80 umol / L,10.15 umol / L VS 2.80 umol / L),and the DBIL of group A was lower than that of group B(P < 0.05).(5)Maternal outcomes : the gestational weeks of delivery in group A and group B were smaller than those in the control group(37.14 weeks VS39.57 weeks,38.00 weeks VS 39.57 weeks)(P < 0.05);the natural delivery rate of group A and group B was lower than that of the control group(40.00 % VS 77.61 %,34.38 % VS 77.61 %)(P < 0.05).There was no significant difference between groups A and B in gestational age or natural delivery rate(P > 0.05).There was no significant difference between the three groups in terms of premature rupture of membranes,postpartum hemorrhage(P > 0.05).(6)Neonatal outcomes : The iatrogenic preterm birth rate in group A and group B was higher than that in the control group(20.51 % VS 0.00 %,15.79 % VS 0.00 %).The spontaneous preterm birth rate in group A was higher than that in the control group and group B(12.82 %VS 1.3 %,12.82 % VS 2.63 %).The difference was statistically significant(P <0.05);There was no significant difference in the rate of iatrogenic premature birth between groups A and B,nor in the rate of spontaneous premature birth between groups B and control(P>0.05).The birth weight of group A and group B was less than that of the control group(2659.74 ± 435.31 g VS 3196.62 ± 408.88 g,2952.11 ±386.05 g VS 3196.62 ± 408.88g).The birth weight of group A was less than that of group B.The body length of group A and group B was less than that of the control group(48.00 cm VS 50.00 cm,49.00 cm VS 50.00cm).The head circumference of group A was smaller than that of control group and group B(32.00 cm VS 33.00 cm,32.00 cm VS 33.00cm),the difference was statistically significant(P < 0.05).There was no significant difference in neonatal head circumference between group B and control group(P > 0.05).The amniotic fluid meconium contamination rate of group A and group B was higher than that of the control group(20.51 % VS 3.90 %;28.95 %VS 3.90 %),the difference was statistically significant(P < 0.05),.The intrauterine distress rate of group A and group B was higher than that of the control group(23.08 % VS 1.30 %;7.89 % VS 1.30 %),the difference was statistically significant(P < 0.05).The intrauterine distress rate of group A was higher than that of group B,and the difference was statistically significant(P < 0.05).The NICU transfer rates of group A and group B were higher than those of the control group(35.90 % VS10.39 %,26.32 % VS 10.39 %),with statistical significance(P < 0.05).There was no significant difference in neonatal Apgar score among the three groups(P > 0.05).Conclusions:(1)ICP is associated with advanced age and low weight gain during pregnancy;(2)Women with ICP may have a higher risk of gestational diabetes,so blood glucose should be monitored during routine prenatal examination.(3)There may be no characteristic changes in hepatobiliary B-ultrasound in ICP patients.In clinical work,hepatobiliary B-ultrasound examination should be routinely performed in ICP patients during pregnancy to exclude hepatobiliary organic diseases.ICP patients with abnormal results of hepatobiliary B-ultrasound have a worse perinatal prognosis.ICP patients with abnormal B-ultrasound results should be actively treated and closely followed up.(4)For ICP patients,coagulation function should be monitored,postpartum hemorrhage should be actively prevented,and abnormalities should be found and treated in time.Active clinical treatment can improve the liver function index of ICP patients,and ICP patients should be found as early as possible and intervened in time.(5)ICP is not the absolute indication of cesarean section.Vaginal delivery should be performed under close monitoring for patients with vaginal delivery conditions.Cesarean section should be performed to terminate pregnancy when patients have indications for obstetric cesarean section.(6)ICP patients with an onset gestational age of less than 34 weeks have a higher rate of neonatal low birth weight,premature delivery,intrauterine distress,and other complications.Obstetricians should attach great importance to ICP patients with onset gestational age less than 34 weeks,in order to improve the perinatal outcome of these women as much as possible. |
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