| Objective:Assessing the impact of potential risk factors in Adverse Perinatal Outcome in Intrahepatic Cholestasis of PregnancyMethod:Data of hospital deliveries records were collected from January2007to December2011from the Second Xiangya Hospital. Clinical data of454cases of patients with ICP and83cases in normal pregnant women who delivered during the same period was randomly selected and the realtaionship between the clinical and laboratory parameters and perinatal outcome outcome were analysed.Results:1. The incidence rate of postpartum hemorrhage, cesarean section, low birth weight neonates, premature neonates, fetal distress, MSAF and fetal death were higher in ICP group than in Control Group. The incidence rates of severe ICP group were higher than the mild ICP group, the differences were statistically significant (P<0.05). In ICP group, the results of TBA, ALT,AST, TBIL and DBIL were27.73±3.34μmol/L,107.90±36.61U/L,72.04±29.22U/L,36.35±13.00μmol/L, and16.98±2.42μmol/L were respectively higher than that of Control Group with results of TBA, ALT,AST, TBIL and DBIL were6.91±2.67μmol/L,16.16±3.65U/L,20.18±6.01U/L,6.94±1.76μmol/L and1.91±0.6μmol/L) respectively, the differences were statistically significant (P<0.05).2. There were no significant differences in low birth weight neonates, premature neonates, fetal distress and MSAF in ICP patients with advanced maternal age. The incidence rate of neonatal asphyxia gradually increased with increasing maternal age, the difference was statistically significant (P<0.05).3. The admission gestational age of ICP from<32wks,32+1wks-34wks,34+1wks～36wks, and>36wks, showed that the mean low birth weight neonates and the incidene rate of fetal distress, neonatal asphyxia, MSAF and fetal death were (1503.29±504g,2099.28±448g,2490.76±497g,3199.15±544g),(93.87%,76.92%,70.14%,25.85%),(44.89%,12.82%,4.47%,1.29%),(6.12%,46.15%,60.44%,14.65%) and (6.12%,5.12%,1.49%,0.43%) respectively. The neonatal birth weight in ICP patients gradually increased with increasing gestational age, however the incidence rates of fetal distress, neonatal asphyxia,MSAF and fetal death gradually decreased, the differences were statistically significant (P <0.05).4. ICP patients with disease duration of<1wk,1-2wks,2-3wks and>3wks, showed incidence rates of low birth weight neonates, premature neonates, fetal distress, neonatal asphyxia, MSAF, and fetal death were (19.85%,36.11%,42.50%,48.46%),(28.67%,31.48%,35.00%,46.15%)(33.82%,50.00%,58.75%,63.84%)(0.73%,4.62%,10.00%,16.92%)(19.11%,21.29%,35.00%,45.38%) and (0.73%,1.85%,2.50%,3.07%) respectively. The incidence rates of low birth weight neonates, premature neonates, fetal distress, neonatal asphyxia, MSAF and featl death gradually increased with longer course of the disease in patients with ICP,the differences was statistically significant (P<0.05).5. ICP patients with higher levels of TBA, ALT, AST, TBIL and DBIL showed that the incidence rates of low birth weight neonates, premature neonates, fetal distress, MSAF and fetal death gradually increased, the differences were statistically significant (P<0.05). In adverse perinantal outcome in ICP patients, the level of TBA, ALT, AST, TBIL and DBIL compared to ICP without adverse perinatal outcome were significantly higher, the differences was statistically significant (P <0.05).6. ICP patients with complications have higher incidence rates of adverse perinatal outcome than ICP patients without complications, the difference was statistically significant (P<0.05).Conclusion:1. The incidence rates of postpartum hemorrhage, cesarean section, low birth weight neonates, premature neonates, fetal distress, MSAF and perinatal death are higher in ICP patients.2. There is a close association beween the ICP maternal age, admission gestational age, duration of cholestasis in pregnancy, ICP with or without complications, the severity of ICP and the adverse perinatal outcome. These may serve as predictors of adverse perinatal outcome in intrahepatic cholestasis of pregnancy. |
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