Analysis Of The Influence Factors Of Intrahepatic Cholestasis Of Pregnancy On Mother And Infant

Research backgroundIntrahepatic Cholestasis of Pregnancy(ICP)is a specific complication of pregnancy,It is characterized by pruritus and abnormal liver function during pregnancy,Increase of serum cholic acid.ICP The incidence varies from 0.1%to 15.6%.There are obvious regional and ethnic differences.The cause is not clea,It may be related to female hormones,heredity and environment.For pregnant women,It mainly causes cesarean section rate,vaginal delivery rate and postpartum hemorrhage by affecting the synthesis and absorption of coagulation factors such as fat soluble vitamin K.Impact on perinatal infants is the main harm,It is one of the main causes of premature birth,fetal distress,neonatal asphyxia,stillbirth,stillbirth and neonatal death,And fetal death often occurs suddenly,which can not be predicted by routine prenatal monitoring.intrahepatic cholestasis of pregnancyFetal acute hypoxia and stillbirth are easy to occur,Timely diagnosis and treatment can reduce the morbidity and mortality of the disease.ObjectiveTo explore the related factors of perinatal outcome in ICP patients.Materials and Methods198 ICP patients with routine obstetric examination and in-patient delivery in the First Affiliated Hospital of Zhengzhou University were selected as the study subjects from January 2017 to June 2018.Among them,154 were single pregnancy,44 were twin pregnancy,aged 20-42 years,with an average age of(29.5±4.8)years,1.7 0.8 pregnancies,and 1 patient had a history of ICP stillbirth.The onset time of ICP was 11 weeks,the latest 42 weeks,and the average time of onset was(34.3±6.4)weeks.Of these,183 were primiparas and 15 were parturients.Another 180 cases of normal pregnant women in our hospital were selected as control group.Obstetric factors:age,parity,pregnancy,gestational age,mode of delivery,skin pruritus,duration of skin pruritus,onset time,serum bile acid concentration,ALT,total bilirubin,direct bilirubin,hypertension,diabetes mellitus,hepatitis B,fetal sex,birth weight;The adverse outcome of delivery:premature delivery,fetal distress,asphyxia,amniotic fluid pollution,and small for gestational age.Finally,obstetric factors were analyzed by single factor analysis,and statistically significant factors were included in Logistic regression analysis model to analyze the risk factors of adverse perinatal outcomes in ICP patients.Results(1)The levels of ALT,AST and TBA in mild group and severe group were significantly higher than those in control group(P<0.05).The levels of TBIL and DBIL in mild group and control group were not significantly different(P>0.05).The levels of TBIL and DBIL in severe group were significantly higher than those in control group(P<0.05).There was no significant difference in S/D index(P>0.05).(2)The termination time of pregnancy in severe group was significantly shorter than that in mild group and control group(P<0.05).The proportion of premature infants in mild group and severe group was significantly higher than that in control group(P<0.05).The proportion of vaginal delivery in mild group and control group was not significantly different(P>0.05).The proportion of vaginal delivery in severe group was significantly lower than that in control group and mild group(P<0.05).There was no significant difference in birth weight among the three groups(P>0.05).There was no significant difference in the proportion of postpartum hemorrhage and fetal growth restriction among the three groups(P>0.05).There was no significant difference in neonatal weight between severe group(2968.1±527.5 g)and mild group(3216.5±468.3 g)and control group(3342.1±516.2 g)(P>0.05).(3)The proportion of fetal distress and meconium contamination in amniotic fluid in mild group and severe group was significantly higher than that in control group(P<0.05),and the proportion of Apgar score less than 7 in mild group and control group had no significant difference(P>0.05).The proportion of neonatal hyperbilirubinemia and neonatal aspiration pneumonia in control group was significantly lower than that in other two groups(P<0.05).The Apgar score of severe group was less than 7,the proportion of neonatal hyperbilirubinemia and neonatal aspiration pneumonia was significantly higher than that of mild group and control group(P<0.05).There was no significant-difference in neonatal mortality,intrauterine fetal and meconium aspiration syndrome among the three groups(P>0.05).(4)105 cases of ICP perinatal adverse outcomes,including age,mode of delivery,onset time,TBA,ALT and other indicators into the single factor regression analysis model,single factor analysis showed that perinatal adverse outcomes were not associated with itching,merger of hepatitis B,etc.(P>0.05),onset time,twin pregnancy,TBA,ALT,DBIL.Hypertension and hypertension are risk factors for perinatal adverse outcomes(P<0.05).(5)High TBA(OR=1.754),onset time(OR=2.968)and twin pregnancy(OR=1.823)were risk factors for adverse perinatal outcomes,and were positively correlated with the incidence of adverse perinatal outcomes(P<0.05).Conclusions:1.ICP maternal clinical manifestations of pruritus as the main manifestation,severe patients with jaundice risk greatly increased;2.ICP maternal mostly showed elevated levels of ALT,AST,TBA,TBIL and DBIL levels,the higher the level of patients with ALT,AST,TBIL and DBIL levels;3.ICP maternal TBA levels are too high,the termination of pregnancy time ahead of schedule.4.ICP maternal fetal distress,amniotic fluid meconium contamination,neonatal hyperbilirubinemia,neonatal aspiration pneumonia risk significantly increased;5.ICP perinatal adverse outcomes and ICP onset time,TBA levels were too high.And twin pregnancy.