PERINATAL FOLLOW UP AND NEONATAL OUTCOMES OF PREGNANCIES WITH OBSTETRIC CHOLESTASIS/PERINATALNO PRACENJE I NEONATALNI ISHODI U TRUDNOCAMA SA OPSTETRICKOM HOLESTAZOM

• Published in: Medicinski pregled Vol. 74; no. 1-4; p. 11
• Main Authors: Krsman, Anita, Baturan, Branislava, Lazarevic, Ana, Grujic, Zorica, Petrovic, Dorde, Dickov, Isidora
• Format: Journal Article
• Language: English
• Published: Drustvo Lekara Vojvodine 01-01-2021
• Subjects: Cesarean section; Deoxycholic acid; Infants (Newborn); Liver; Maternal health services; Obstetrics; Pregnant women
• ISSN: 0025-8105
• DOI: 10.2298/MPNS2102011K

Introduction. Obstetric cholestasis is the most common liver disease during pregnancy, which is predominantly associated with fetal complications. Material and Methods. This retrospective study included a total of 44 pregnant women with obstetric cholestasis who gave birth at the Clinic of Obstetrics and Gynecology, Clinical Center of Vojvodina, Novi Sad, from January 1, 2014 to December 31, 2018. Results. The average maternal age was 34 years. The mean gestational age at diagnosis of obstetric cholestasis was 31 weeks, and at the time of delivery 35 weeks of gestation. Abdominal pruritus was the main symptom of the disease affecting 72.72% of patients. The mean bile acid level in the blood at the time of diagnosis was 25.26 [micro]mol/L. Twenty nine patients (65.90%) gave birth vaginally, while 15 (34.09%) underwent cesarean section. The main maternal complication was postpartum hemorrhage. The average blood loss was 567 ml. There were no maternal deaths or stillbirths. The average newborn birth weight was 2830 g. Respiratory distress syndrome was diagnosed in 8 newborns (15.09%). The mean Apgar score at 1minute was 7, while at 5 minutes it was 9. Conclusion. Individual approach, continuous clinical and laboratory monitoring with adequate therapeutic treatment are necessary in patients with obstetric cholestasis. Key words: Cholestasis; Infant, Newborn; Risk Factors; Perinatal Care; Pregnancy Outcome; Pregnancy Complications; Signs and Symptoms Uvod. Opstetricka holestaza je najcesca bolest jetre u trudnoci, koja je povezana sa komplikacijama prvenstveno po plod. Materijal i metode. Retrospektivna studija obuhvatila je 44 trudnice sa opstetrickom holestazom, porodene na Klinici za ginekologiju i akuserstvo Klinickog centra Vojvodine u Novom Sadu, u periodu od 1. januara 2014. do 31. decembra 2018. godine. Rezultati. Prosecna starost majki iznosila je 34 godine. Prosecna gestacijska starost trudnoca u vreme postavljanja dijagnoze bila je 31 nedelja, a u vreme porodaja 35 gestacijskih nedelja. Svrab je bio dominantan simptom bolesti i najcesce se pojavljivao u predelu trbuha (72,72%). Prosecna vrednost zucnih kiselina u krvi u momentu postavljanja dijagnoze bila je 25,26 [micro]mol/L. Dvadeset devet pacijentkinja (65,90%) porodeno je vaginalnim putem, dok je 15 (34,09%) trudnica porodeno carskim rezom. Glavna maternalna komplikacija bila je postpartalno krvarenje. Prosecan gubitak krvi bio je 567 ml. Nije bilo maternalnih smrti ni mrtvorodene dece. Prosecna telesna masa na rodenju iznosila je 2.830 g. Respiratorni disters sindrom dijagnostikovan je kod osmoro novorodencadi (15,09%). Prosecna ocena po Apgaru u prvom minutu iznosila je 7, dok je u petom minutu bila 9. Zakljucak. Individualni pristup, kontinuirano klinicko i laboratorijsko pracenje uz adekvatan terapijski tretman neophodni su kod pacijentkinja sa opstetrickom holestazom. Kljucne reci: holestaza; novorodence; faktori rizika; perinatalna nega; ishod trudnoce; komplikacije u trudnoci; znaci i simptomi