Analysis Of Fetal Growth And Maternal And Fetal Pregnancy Outcomes In 108 Cases Of Mild Simple Intrahepatic Cholestasis Of Pregnancy

Objective The research is to collect the basic clinical data of mild simple intrahepatic cholestasis of pregnancy（ICP）patient at first pregnancy presented in different stages of gestation and part of normal first pregnancy in recent 3 years.And analyze the differences including common onset gestation of the disease,mian clinical manifestation and auxiliary examination among the groups（the control group,the mild simple of early onset group and late onset group）.For further,we compare the data about fetal growth,pregnancy outcome and perinatal complications among groups.We aim to provide beneficial clinical manifestions for mild simple ICP patient,who need early diagnosis and special treatment,at the same time the incidence of adverse pregnancy outcome can be reduced.Methods The clinical data of the mild simple ICP patients（n=118;all for the first pregnancy;No other complications except for ICP）and the normal pregnant（n=75;all for the first pregnancy;No complications）in our hospital from the year 2015 to 2017 was retrospectively analyzed.The mild simple ICP patient was divided into the early onset group（n=51;ICP diagnosis before 28th week）and the late onset group（n=67;ICP diagnosis during 29th and 41st week）.We compared the basic clinical data including the onset gestation,the incidence of maternal pruritus,the level of total bile acid（TBA）,the level of Alanine aminotransferase（ALT）and Aspartate aminotransferase（AST）among the groups.Moreover we analyzed the parameters of fetal growth（fetal biparietal diameter（BPD）and femur length（FL）at 32nd week and 36th week）,pregnancy outcome（the incidence of cesarean section,premature rupture of membranes and amniotic fluid）and perinatal outcome（the incidence of premature birth,fetal distress and neonatal birth weight）among the groups.Result（1）General clinical data:There was no significant differences about the average gestational age among the groups（P>0.05）.The average incidence of gestational week of mild simple early and late onset of ICP group was 25.63±1.79 and 34.91±3.95.（2）Clinical manifestation and laboratory examination:The incidence of maternal pruritus of mild simple early onset and late onset ICP group were all higher than those in control group（P<0.001）.There was no significant difference between ICP groups（P>0.05）.The results of TBA:The data in mild simple early and late onset of ICP group was higher than control group（P>0.001;P>0.001）,there was no significant difference between the two groups（P>0.05）.The results of ALT detection:The data in mild simple early and late onset of ICP group were larger than control group（P>0.001;P>0.001）,but there was no significant difference between the two（P>0.05）.The trend of comparative analysis of AST is the same as that of ALT.（3）Fetal growth:The BPD and FL of fetus in mild simple early onset ICP group at 32～32⁺⁶weeks of gestation were smaller than control group（P<0.01/P<0.01）.Moreover the BPD and FL in mild simple early and late onset ICP group at 36～36⁺⁶weeks of gestation were smaller than control group（P<0.001/P<0.001;P<0.05/P<0.05）,and early onset group reduced more obviously（P<0.05/P<0.05）.（4）Pregnancy outcome:the cesarean section rate of mild simple early and late onset ICP group were higher than control group（P<0.001;P<0.001）,and early onset group increased more significantly（P<0.01）;The premature rupture of membranes rate and amniotic innormal rate of mild simple early onset ICP group were significantly lower than the control group（P<0.05;P<0.05）.（5）Perinatal outcomes:The preterm birth rates of mild simple early and late onset ICP group were higher than control group（P<0.001,P<0.05）,and the early onset increased more significantly（P<0.05）;The incidence of fetal distress of mild simple early onset ICP group was higher than that of control group（P<0.05）.The neonatal birth weight of mild simple early and late onset ICP group were lower than the control group（P<0.001;P<0.05）and neonatal birth weight of early onset decreased more than that of late onset group（P<0.001）.Conclusion Early onset mild ICP has great effects on fetal growth,pregnancy outcome and perinatal complocations.This may be related with durative effect of bile acid on placenta and fetus.Early diagnosis and proper treatment of early onset ICP may help to improve outcomes of mothers and fetus.