Analysis Of Blood Biochemistry Abnormality And Perinatal Outcome Of Early-onset Intrahepatic Cholestasis Of Pregnancy

Objective:To analyze the blood biochemistry abnormality and perinatal outcome of early-onset intrahepatic cholestasis of pregnancy(ICP), and to provide the evidences and guides for the diagnosis and treatment of early-onset ICP patients.Methods:A total of201ICP cases were collected in the Women’s Hospital School of Medicine Zhejiang University between June2013and April2014. According to the onset time of ICP, patients were divided into early-onset ICP group (onset time<32gestational weeks,75cases)and late-onset ICP group (onset time≥32gestational weeks,126cases). At the same period,100nomal cases were used as contral group. All cases exclude primary liver diseases, twin or multiple pregnancy, severe pre-eclampsia, complete placenta previa and other complications of pregnancy. The biochemical indices (eg. TBA, CG,ALT,AST and ALP) and perinatal outcome (eg. gestational weeks, amniotic fluid condition, birth weight, and Aparg score) of each group were assessed.Results:(1) When the diagnosis was made for the first time, the maternal serum concentrations of total bile acid (TBA) and glycocholic acid (CG) in early-onset ICP group were(58.9±36.9)μmol/L and(1800.7±866.3)μg/dl, respectively; while TBA and CG in late-onset ICP group were (30.7±21.4) μmol/L and (1118.8±684.8) μg/dl, and the difference between the two groups was statistically significant (P<0.05).(2) The maternal serum level of alanine aminotransferase (ALT) and aspartate aminot-ransferase (AST) in late-onset ICP group were (72.4±38.7) U/L and (54.6±26.0) U/L, ALT and AST in early-onser ICP group were (46.6±28.8) U/L and (42.2±22.3) U/L, while ALT and AST in control group were (11.6±7.7) U/L.(17.2±6.7) U/L, the difference between every two groups was statistically significant(P<0.05). The alkaline phosphatase of early-onset ICP group, late-onset ICP group and the control group were (204.1±81.4) U/L,(144.4±35.2) U/L and (158.0±47.9) U/L. The difference between the early-onset ICP group and the late-onset ICP group, as well as the difference between late-onset ICP group and the control group, were statistically significant (P<0.05). Inversely, there was no significant difference in ALP between early-onset ICP group and control group (P>0.05).(3)There was significant differences in average diagnosis gestational weeks between the two groups [early-onset ICP group(23.6±6.34) weeks and late-onset ICP group (36.3±2.52) weeks]. Also the early-onset ICP group had significant higher (P<0.05) incidence of developing into severe ICP (65.3%) than the late-onset group(27.8%).(4)The differences in average birth weight and gestational weeks at delivery between every two groups was significant [early-onset ICP group:(2702.7±512.27) g and (36.19±2.45) weeks; late-onset ICP group:(3118.8±484.31) g and(37.95±1.79)weeks; control group:(3255.5±437.16)g and(37.95±1.79)weeks].(5) The early-onset ICP group had significant higher incidence of premature delivery (50.7%), and cesarean section (84%) when compared to the late-onset ICP group (19.8%and68.3%)and the control group(8%and39%).(6)There was no significant differences of incidence of fetal distress and neonatal asphyxia between every two groups (P>0.05). Conclusion:The early-onset ICP patients presented worse clinical mani-festations than late-onset ICP patients. The early-onset ICP is more likely to lead to develop into severe ICP and we should select suitable modes of delivery to improve the adverse pregnancy outcomes.