Analysis Outcome Of Perinatal Outcome For Intrahepatic Cholestasis Of Pregnancy Total Bile Acid

Background:Intrahepatic cholestasis of pregnancy(Intrahepatic cholestasis of pregnancy, ICP) had little effect on pregnant women caused by the main threat to the safety of the fetus, can cause fetal distress, fetal death,premature delivery etc.. ICP in some regions of high incidence, the specific pathogenesis is still not clear.Hydrophobic bile acids with cell toxicity, will cause the damage of oxygen free radicals and bilirubin levels increased inhibition of oxidative phosphorylation. Under normal circumstances, fetal bilirubin, bile acid is absorbed by the parent, ICP patients with maternal bile acid levels were significantly increased, elevated levels of bile acid in umbilical cord blood, therefore fetal cell energy metabolism, causing adverse perinatal outcomes.Objective :In patients with ICP and normal pregnancy women as the research object. Analysis the clinical characteristics of patients with ICP, analysis of liver function biochemical changes, in accordance with the total bile acid level groups, analysis of perinatal outcome, and to explore and ICP women around the influence factors of perinatal outcome, the analysis of time of ICP, total bile acid level impact on perinatal outcome of pregnancy.Methods :Retrospective analysis of selected 2012 January to June 2015 in the First Affiliated Hospital of Suzhou University, Yancheng City Maternal and child health hospital 198 cases of routine antenatal examination, hospital delivery of ICP patients as the research object, in addition to select the same period normal pregnant women180 cases as the control group. The clinical data of patients were collected, and the clinical manifestations of the patients were recorded. The levels of total bile acids(bile acid Total, TBA) were determined. In accordance with the total bile acid determination level are grouped and TBA levels lower than 40 μ mol / L for mild group, a total of 118 cases, TBA level not less than 40 μ mol / L for severe group, a total of 80 patients. Venous blood. Determination of glutamic pyruvic transaminase(alanine aminotransferase ALT), aspartate aminotransferase(AST AST), direct bilirubin(DBIL, direct bilirubin), total bilirubin(TBIL), total bilirubin) and index level. Compared two groups of maternal outcome of pregnancy, maternal time ofonset, signs, laboratory parameters and complications, according to maternal pregnancy outcome analysis of influencing factors of ICP patients with adverse pregnancy outcomes, there will be significant factors into the status and regression analysis software, analysis of ICP patients perioperative risk factors for adverse perinatal outcomes.Results :(1)Mild group ALT, AST, TBA levels and severe group was significantly higher than control group ALT, AST, TBA(P <0.05),mild group TBIL, DBIL levels and control group was not significantly different(P> 0.05), severe patients TBIL, DBIL level was significantly higher than the control group(P <0.05). PI values severe group was significantly higher in mild group and control group(P <0.05).Severe group S / D, mild group and control group was no significant difference(P> 0.05).Severe group RI and mild group, the control group was no significant difference(P> 0.05).(2)Severe group termination of pregnancy(35.2 ± 1.4) weeks was significantly shorter than mild group(38.1 ± 1.7) weeks and the control group(38.5 ± 1.8) weeks(P<0.05), the mild proportion of preterm children(11.8%), and severe group(85.0%) was significantly higher than the control group(5.0%)(P <0.05), mild group(41.5%) and the control group of vaginal delivery rate(61.7%) was not significantly different(P> 0.05), the proportion of severe vaginal delivery group(6.3%) was significantly lower than the control group(61.7%) and mild group(41.5%)(P <0.05), Severe birth weight group(2968.1 ±527.5) g and mild group(3216.5 ± 468.3) g, the control group(3342.1 ± 516.2) g no significant difference(P> 0.05),Severe group of postpartum hemorrhage(5.0%), the proportion of fetal growth restriction(8.7%), mild group of postpartum hemorrhage(3.4%),the proportion of fetal growth restriction(6.8%) and the control group of postpartum hemorrhage(3.3%), fetal growth limited proportion(5.0%) had no significant difference(P> 0.05).(3) Mild group, fetal distress(13.6%), amniotic fluid meconium pollution ratio(11.0%) and severe group patients with fetal distress(27.5%), amniotic fluid meconium pollution ratio(40.0%) was significantly higher than that in the control group of fetal distress(6.7%), amniotic fluid meconium pollution ratio(5.0%)(P < 0.05). Severe group of Apgar score less than 7(8.7%), who were admitted to the NICU(22.5%), neonatal hyperbilirubinemia(62.5%), neonatal inhalation pneumonia proportion(32.5%) wassignificantly higher than that of the mild group, Apgar score less than 7 points(3.4%), who were admitted to the NICU(5.1%), neonatal hyperbilirubinemia(21.2%), neonatal inhalation pneumonia proportion(8.5%) and the control group Apgar score less than 7points(1.7%), who were admitted to the NICU(3.3%), neonatal hyperbilirubinemia(5.0%),neonatal aspiration pneumonia proportion(3.3%)(P < 0.05). Control groups of patients with neonatal death(0%), fetal(0%), meconium aspiration comprehensive syndrome(0%)and mild group neonatal death(0%), fetal(0.8%), meconium aspiration comprehensive sign proportion(0.8%) and severe group neonatal death(1.3%), fetal(2.5%), meconium aspiration syndrome proportion(2.5%) had no significant difference(P > 0.05).(4)ICP adverse perinatal outcomes of 105 cases,the age, mode of delivery, time of onset, TBA, ALT and other factors were included into the model of single factor regression analysis, univariate analysis showed that adverse perinatal outcomes and skin itching,hepatitis B and other merger-independent(P> 0.05), time of onset, TBA, ALT, DBIL high hypertension adverse perinatal the outcome of risk factors(P <0.05).(5) Logistic regression analysis model, time of onset OR=2.968, TBA high(OR=1.754 and hypertension OR=1.823 is perioperative risk factors for adverse perinatal outcomes, with Wai adverse perinatal outcomes occurred rate showed a positive correlation(P < 0.05).Conclusion:(1)ICP multi maternal liver function abnormalities associated with higher concentrations of TBA, liver function abnormalities more severe.(2) TBA level of patients with ICP high confining perinatal outcome was poor, fetal distress, amniotic fluid meconium contamination, neonatal hyperbilirubinemia and inhalation pneumonia ratio increased significantly(P < 0.05).(3) The incidence of hypertension and the incidence of early time is a risk factor for adverse perinatal outcomes in patients with ICP, ICP patients with adverse perinatal outcome and the level of patients with TBA is positively related to the degree of diagnosis and treatment will help to improve the prognosis of perinatal infants.