Effect Of Intrahepatic Cholestasis On Maternal Coagulation Function And Perinatal Outcome During Pregnancy

Objective: to investigate the effect of Intrahepatic cholestasis during pregnancy(Intrahepatic cholestasis during pregnancy,ICP)on maternal coagulation function and pregnancy outcome,so as to obtain clinical evidence of early detection,early diagnosis and early treatment,avoid the occurrence and development of complications,and obtain the best pregnancy outcome.Methods: Pregnant women who were registered and delivered in gansu provincial people's hospital from January 1,2018 to January 1,2019 were selected as the research objects.According to the inclusion criteria and exclusion criteria,216 pregnant women were selected as the experimental group: 1.They were divided into two groups according to different Serum total bile acid(TBA)concentrations,and 156 cases in the mild ICP group(10 living mol/L?TBA < 40 living mol/L).60 patients in severe ICP group(TBA?40 refresh mol /L);216 normal pregnant women were randomly selected as the control group.The effects of Prothrombin time(PT),Activated partial thromboplastin time(APTT),Fibrinogen(FIB),Thromb in time(TT)and Platelet(PLT)were studied.The perinatal outcomes,fetal distress,premature delivery,amniotic fluid fecal contamination,low birth weight and neonatal asphyxia were analyzed with different severity of ICP.3.To further clarify the influence of ICP on the perinatal delivery,216 samples from the experimental group were stratification according to the onset gestational age,specifically: group A: 87 cases at 28 weeks ? 34 weeks gestational age;3.Group B: 129 cases with gestational age ?34 weeks.The incidence of fetal distress,premature delivery,amniotic fluid fecal contamination,low birth weight and neonatal asphyxia were observed and analyzed.Results: 1.There was no significant difference between the mild ICP group and the severe ICP group(P>0.05).APTT and FIB in mild ICP group and severe ICP group were significantly higher than those in control group,and the difference was statistically significant(P<0.05).TT and PLT in the mild ICP group and the severe ICP group were significantly lower than those in the control group,and the difference was statistically significant(P<0.05).APTT,FIB and TT in the severe ICP group were significantly higher than those in the mild ICP group,and PLT was significantly lower than those in the mild ICP group,with statistically significant differences(P<0.05).2.Perinatal outcomes of different degrees of ICP: the incidence of fetal distress,premature delivery,amniotic fluid fecal contamination,low birth weight and neonatal asphyxia in severe ICP group was higher than that in mild ICP group and control group,and the difference was statistically significant(P < 0.01).The incidence of fetal distress,premature delivery,low birth weight and neonatal asphyxia in mild ICP group was higher than that in control group,but the difference was not statistically significant(P>0.01).The fecal staining rate of pregnant women in the control group was lower than that in the mild ICP group,and the difference was statistically significant(P<0.01).3.The rate of postpartum hemorrhage in the experimental group was significantly higher than that in the control group,and the difference was statistically significant(P<0.05).4.Comparison of perinatal outcomes of ICP patients with different gestational weeks: the incidence of fetal distress,premature delivery and low birth weight in group A was higher than that in group B,and the difference was statistically significant(P< 0.05).There was no significant difference in the rates of amniotic fluid fecal contamination and neonatal asphyxia between groups A and B(P >0.05).Conclusions: 1.ICP affects the coagulation mechanism of pregnant women to a certain extent,and increases the risk of postpartum hemorrhage in patients.2.The incidence of fetal distress,premature delivery,amniotic fluid fecal contamination,low birth weight and neonatal asphyxia in severe ICP group was significantly higher than that in mild ICP group and control group.The worse the incidence of ICP was,the worse the perinatal prognosis was.3.The earlier the onset of ICP,the higher the incidence of fetal distress,premature delivery and low birth weight.The longer the onset time of ICP,the worse perinatal prognosis.Therefore,as soon as pregnant women find out and diagnose ICP,they should actively cooperate with the doctor for treatment,pay close attention to the fetal condition,appropriately extend the gestational age,and terminate pregnancy in time,so as to achieve a good pregnancy outcome.