| Intrahepatic cholestasis of pregnancy (ICP), characterized by pruritus, jaundice and biochemical evidence of cholestasis, occures in the second and third trimester of pregnancy and disappears quickly after delivery. The main pathology is abnormal metablism of hormones and bile acid. ICP is considered as a benign disease due to the mild effects on maternal ountcome. However, it increases the risk of fetal distress, premature delivery, meconium contamination in amniotic fluid, and even stillbirth. ICP occures more frequantly in high-risk pregnancies such as pregnancy-induced hypertension and mutiple pregnancy. Thepathogenesis of fetal hypoxia in ICP is still unknown. No valuable mean is available to predict fetal distress and fetal death.Erythropoietin (EPO) is one of the most important factors to stimulate the differentiation and maturation of pluripotentiol stem cell. EPO is thynthesized in response to hypoxia and anemia in animal model. EPO cann't pass the placenta and umbilical cord blood erythropoietin level reflects fetal saturity of oxygen. It was found that EPO increased after fetal expossure to hypoxia for several hours. Thus, EPO has been considered a good marker for fetal chronic hypoxia. The ratio of amniotic fluid EPO to umbilical vein blood EPO keeps level. Increases in the number of red blood cell, hematocrit and reticulocyte in cord blood also imply the presence of fetal distress. Blood gas analysis of cord blood is sensitive to diagnose fetal distress.The aims of this study were to clarify the type of fetal distress and to find a possible marker predicting the onset of fetal distress. Considering the features of EPO, we measured EPO concentration in both cord blood and amniotic fluid and analyzed the connection of EPO levels to fetal hypoxia.We choose 47 cases of ICP, who were further divided into6meconium-contaminated group and non-contaminated group according the status of amniotic fluid, and 47 normal pregnant women. All subjects had no uterine contraction. Samples of amniotic fluid (AF) and cord blood were obtained in selective Cesarean Section. EPO concentrations in AF and cord blood, cord blood gas analysis, reticulocyte and red cells number were determined, and neonatal Apgar score was recorded. There were nine cases in ICP group with meconium contamination, 38 in ICP group without meconium contamination and 47 in control group. The mean ages were comparable among the groups. However, the gestational ages were significantly different among the groups (P<0. 01, 36. 22?. 33 weeks for ICP group with meconium comtamination, 37. 76?.42 weeks for ICP group without meconium contamination and 38.77 + 0. 87 weeks for control group). The neonatal weight were 2977. 78 + 493. 78 gram for ICP group with meconium contamination, 3218. 95 + 516. 27 gram for ICP group without meconium contamination and 3446.81 + 365.26 gram for control group. The neonatal weights were not significantly different between ICP groups with and without meconium contamination, but those of both ICP groups were significantly different from that of control group (P<0. 01). Analysis of covariance showed that neonatal weights were comparable7when the influence of gestational age was excluded, indicating that neonatal weights were appropriate for gestational ages. The glycocholic acid levels in maternal serum, cord blood and AF were not significantly different between ICP with meconium contamination and without contamination (P>0.05). Cord blood EPO levels of ICP group with contamination, ICP group without contamination and control group were 13.27 ?.41 (mlU/ml), 22. 31 ?9. 27 and 20. 44 ?9. 70 respectively. AF EPO levels of ICP group with contamination, ICP group without contamination and control group were 7. 26 + 4. 41, 12. 12 ?.08 and 9. 84?. 68 respectively. EPO levels in both cord blood and AF of ICP group with meconium contamination were significantly different when compared to those of the other groups (P<0. 05). Reticulocyte counts in cord blood were 3.58 ?.19%, 4.40 ?.81% and 4.17 + 0.78% for th...
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