Effects of Combined Treatment with Transmentil and Ursofalk on Liver Function and Perinatal Prognosis in Pregnant Women with Intrahepatic Cholestasis of Pregnancy

2019 ◽  
Vol 08 (06) ◽  
pp. 404-410
Author(s):  
雅萍 赵
Keyword(s):  
Liver Function ◽  
Pregnant Women ◽  
Intrahepatic Cholestasis ◽  
Combined Treatment ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Cholestasis Of Pregnancy

scholarly journals Obstetric Cholestasis: A Review and Update

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Olawumi Adaramodu ◽  
Anthony Kodzo-Grey Venyo
Keyword(s):  
Liver Function ◽  
Bile Acids ◽  
Intrahepatic Cholestasis ◽  
Liver Function Tests ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Third Trimester ◽  
Serum Bile Acids ◽  
Function Tests ◽  
Cholestasis Of Pregnancy ◽  
In Pregnancy

Obstetric cholestasis (OC) is a liver disorder that occurs in the late second and early third trimester of pregnancy characterized by pruritus with increased serum bile acids and other liver function tests. The pathophysiology of OC is still not completely understood. The symptoms and biochemical abnormality rapidly resolve after delivery. OC is associated with an increased risk of adverse obstetrical outcomes. The aetiology of obstetric cholestasis of pregnancy is poorly understood and is thought to be complicated and multifactorial.  OC typically occurs in the late second trimester when the oestrogen levels are the highest in pregnancy. The most common complaint is generalized intense pruritus, which usually starts after the 30th week of pregnancy. Pruritus can be more common in the palms and soles and is typically worse at night. Other symptoms of cholestasis, such as nausea, anorexia, fatigue, right upper quadrant pain, dark urine, and pale stool, can be present. Clinical jaundice is rare but may present in 14% to 25% of patients after 1 to 4 weeks of the onset of pruritus. Some patients also complain of insomnia as a result of pruritus. Generally, physical examination is unremarkable except for scratch marks on the skin from pruritus. Pruritus is a cardinal symptom of intra-hepatic cholestasis of pregnancy (ICP) and may precede biochemical abnormalities. The diagnosis of intrahepatic cholestasis of pregnancy is via the presence of clinical symptoms pruritus in the third trimester with elevated maternal total serum bile acids and excluding other diagnoses, which can cause similar symptoms and lab abnormalities. Fasting blood samples should be used to check for the total bile salt acid level as it can become elevated in the postprandial state. Once the diagnosis of OC of pregnancy is confirmed, immediate treatment is necessary, and the primary goal of therapy is to decrease the risk of perinatal morbidity and mortality and to alleviate maternal symptoms. Maternal pruritus can be alleviated with use of moisturisers and oral antihistamines. Ursodeoxycholic acid (UDCA) is the drug of choice for the treatment of ICP. Many authors have advocated elective early delivery of women with intrahepatic cholestasis of pregnancy to reduce the risk of sudden foetal death. The Royal College of Obstetricians and Gynaecologists recommends induction of labour after 37+0 weeks of gestation. Obstetric cholestasis of pregnancy is not an indication for Caesarean delivery. Postpartum pruritus typically disappears in the first 2 to 3 days following delivery, and serum bile acid concentrations will normalize eventually. ICP is not a contraindication to breastfeeding, and mothers with a history of ICP in pregnancy can breastfeed their infants. Postpartum monitoring and follow up of bile acids and liver function tests should be done in 4-6 weeks to ensure resolution. Women with the persistent abnormality of liver function test after 6 to 8 weeks require investigation for other aetiologies.

scholarly journals Characterization of gut microbiota associated with clinical parameters in intrahepatic cholestasis of pregnancy

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Rong Li ◽  
Xuehai Chen ◽  
Zhongzhen Liu ◽  
Yan Chen ◽  
Chuan Liu ◽  
...  
Keyword(s):  
Gut Microbiota ◽  
Pregnant Women ◽  
Intrahepatic Cholestasis ◽  
Premature Delivery ◽  
Clinical Parameters ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Control Groups ◽  
And Control ◽  
Cholestasis Of Pregnancy

Abstract Background Intrahepatic cholestasis of pregnancy (ICP) is a liver disorder that specifically occurs in pregnancy. Elevated levels of liver transaminases aspartate aminotransferase, alanine aminotransferase and serum bilirubin levels are common biochemical characteristics in ICP. The disorder is associated with an increased risk of premature delivery and stillbirth. The characterization of the potential microbiota in ICP could go a long way in the prevention and treatment of this pregnancy disease. Methods A total of 58 patients were recruited for our study: 27 ICP patients and 31 healthy pregnant subjects with no ICP. The V3 and V4 regions of the 16S rDNA collected from fecal samples of both diseased and control groups were amplified. 16S rRNA gene amplicon sequencing was then performed on gut microbiota. Sequencing data were analyzed and the correlation between components of microbiota and patient ICP status was found. Related metabolic pathways, relative abundance and significantly different operational taxonomic units (OTUs) between ICP and controls were also identified. Results Elevated levels of total bile acid, ALT, AST, Dbil and Tbil were recorded or observed in ICP subjects as compared to the control. Gut microbiota in pregnant women was dominated by four major phyla and 27 core genera. PCoA analysis results indicated that there was no significant clustering in Bray–Curtis distance matrices. Our results showed that there was a correlation between specific OTUs and measured clinical parameters of pregnant women. Comparison at the different taxonomy levels revealed high levels of abundance of Blautia and Citrobacter in ICP patients. At the family level, Enterobacteriaceae and Leuconostocaceae were higher in ICP patients. 638 KEGG Orthologs and 138 pathways significantly differed in the two groups. PLS-DA model with VIP plots indicated a total of eight genera and seven species were key taxa in ICP and control groups. Conclusions Our research indicated that although there was no significant clustering by PCoA analysis, patients with ICP have increased rare bacteria at different phylogenetic levels. Our results also illustrated that all 638 KEGG Orthologs and 136 in 138 KEGG pathways were less abundant in ICP patients compared to the controls.

Association of ABCB4 and ABCB11 nucleotide variants with intrahepatic cholestasis of pregnancy

2019 ◽  
Vol 88 (4) ◽  
pp. 209-217
Author(s):  
Milena Gruszczyńska-Losy ◽  
Adrianna Mostowska ◽  
Łukasz Adamczak ◽  
Paweł Jagodziński ◽  
Ewa Wender-Ożegowska ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Intrahepatic Cholestasis ◽  
Clinical Symptoms ◽  
Melting Curve ◽  
Liver Disorder ◽  
Melting Curve Analysis ◽  
Control Group ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Increased Risk ◽  
Cholestasis Of Pregnancy

Background: Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disorder during gestation. The exact pathogenesis of ICP is multifactorial and still unclear. Therefore, our study aimed to check whether the selected ABCB4and ABCB11nucleotide variants are associated with an increased risk of ICP. Methods:ICP was diagnosed based on clinical symptoms characteristic of this disease and confirmed by increase in serum bile acids and transaminases, spontaneous resolution of clinical symptoms and normalization of laboratory tests after delivery. The total of 86 pregnant women meeting the criteria were included into the study. Healthy pregnant women with uncomplicated pregnancy served as control group (n=310). Sixcommon nucleotide variants in theABCB11and ABCB4genes were genotypedwith the use of high-resolution melting curve analysis. Conclusion:Our study did not show any significant association of analysed ABCB4and ABCB11nucleotide variants with the increased risk of intrahepatic cholestasis of pregnancy.

scholarly journals Comparative Proteomics Analysis of Placenta from Pregnant Women with Intrahepatic Cholestasis of Pregnancy

PLoS ONE ◽  
2013 ◽  
Vol 8 (12) ◽  
pp. e83281 ◽  
Author(s):  
Ting Zhang ◽  
Yueshuai Guo ◽  
Xuejiang Guo ◽  
Tao Zhou ◽  
Daozhen Chen ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Intrahepatic Cholestasis ◽  
Comparative Proteomics ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Proteomics Analysis ◽  
Cholestasis Of Pregnancy

scholarly journals The Role of Steroid Hormones in the Development of Intrahepatic Cholestasis of Pregnancy

2015 ◽  
pp. S203-S209 ◽  
Author(s):  
A. PAŘÍZEK ◽  
M. DUŠKOVÁ ◽  
L. VÍTEK ◽  
M. ŠRÁMKOVÁ ◽  
M. HILL ◽  
...  
Keyword(s):  
Liver Function ◽  
Bile Acids ◽  
Steroid Hormones ◽  
Intrahepatic Cholestasis ◽  
Point Of View ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Hepatic Transaminases ◽  
Exogenous Factors ◽  
Cholestasis Of Pregnancy

Intrahepatic cholestasis of pregnancy (ICP) is a disorder of liver function, commonly occurring in the third trimester but sometimes also as soon as the end of the second trimester of pregnancy. Symptoms of this disorder include pruritus, plus abnormal values of bile acids and hepatic transaminases. After birth, symptoms disappear and liver function returns to normal. Though ICP is relatively non-complicated and often symptomatically mild from the point-of-view of the mother, it presents a serious risk to the fetus, making this disease the subject of great interest. The etiology and pathogenesis of ICP is multifactorial and as yet not fully elucidated. Hormonal factors likely play a significant role, along with genetic as well as exogenous factors. Here we summarize the knowledge of changes in steroid hormones and their role in the development of intrahepatic cholestasis of pregnancy. In addition, we consider the role of exogenous factors as possible triggers of steroid hormone changes, the relationship between metabolic steroids and bile acids, as well as the combination of these factors in the development of ICP in predisposed pregnant women.

scholarly journals Perinatal outcomes and intrahepatic cholestasis of pregnancy: a prospective study

2019 ◽  
Vol 8 (3) ◽  
pp. 1177
Author(s):  
Sangeeta Parihar ◽  
Swatantar Singh
Keyword(s):  
Pregnant Women ◽  
Intrahepatic Cholestasis ◽  
Postpartum Haemorrhage ◽  
Preterm Labour ◽  
Perinatal Outcomes ◽  
P Value ◽  
Maternal Outcomes ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Fetal Outcomes ◽  
Cholestasis Of Pregnancy

Background: Women with intrahepatic cholestasis of pregnancy (ICP) have an increased risk for postpartum haemorrhage, dyslipidaemia, preterm labour and operative interference. Fetus in ICP has been associated with an increased incidence of preterm labour, preterm prelabour rupture of membrane, fetal distress, abnormal CTG, meconium staining, spontaneous intrauterine death. The present study was done to evaluate the perinatal outcomes – maternal outcomes and fetal outcomes of ICP.Methods: This was a prospective observational study carried out in a tertiary care teaching hospital. Total 1100 pregnant women were screened during the study period. Patients with ICP were identified in maternity care units after eliciting history about itching. Pregnancies with pregnancy induced hypertension and other liver diseases in pregnancy were excluded.Results: 62 pregnant women with prevalence rate of 5.64% have been found to be suffering from ICP. The most frequently affected (22, 35.48%) age-group with ICP were belong to age > 35 years. A majority of pregnant women with intrahepatic cholestasis of pregnancy was of multipara. ICP was highly significantly associated with small for gestational age (SGA, p-value: 0.0003); abnormal cardiotocography (CTG, p-value: 0.0002); and meconium stained liquor (p-value: 0.0001). Caesarean section as mode of delivery found significantly associated (p-value: 0.0033) with ICP. Insomnia (p-value: 0.0045); dyslipidemia (p-value: 0.0011); and postpartum haemorrhage (p-value: 0.0122) were also found significantly with ICP.Conclusions: ICP can adversely affect fetal as well as maternal pregnancy outcomes. Maternal outcomes have good prognosis, but fetal outcomes can be improved by timely and effective intervention.

Psycho-emotional state of women with intrahepatic cholestasis of pregnant women after the use of assisted reproductive technologies

2020 ◽  
pp. 31-35
Author(s):  
O.G. Boychuk ◽  
◽  
T.V. Kolomiichenko ◽  
N.E.N. Ebae ◽  
◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pregnant Women ◽  
Intrahepatic Cholestasis ◽  
Comparison Group ◽  
Assisted Reproductive Technologies ◽  
Reproductive Technologies ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Psychoemotional State ◽  
Cholestasis Of Pregnancy

We can assume a deterioration in the psychoemotional state and a decrease in the quality of life in women after assisted reproductive technologies (ART) with intrahepatic cholestasis of pregnancy (ICP), but no scientific information was found on this issue. The objective: to assess the psychoemotional state of pregnant women with ICP after using ART. Materials and methods. We examined 40 pregnant women after ART with the manifestations of ICP (main group) and 40 – without the manifestations of ICP (comparison group). The presence of vegetative dysfunction syndrome was assessed (according to A.M. Wayne); quality of sleep, especially falling asleep and waking up (A.M. Vein, Yu.I. Levin); anxiety level using the test Spielberg in the modification by Hanin, the presence and severity of depression on the Beck scale; quality of life according to the questionnaire SF-36. The data were processed by methods of variation statistics. Results. In pregnant women after ART with ICP, the total number of points on the A.M. Vein questionnaire is 3.5 times higher than the threshold value of 15 points (median 52 [45, 60] points versus 36 [28; 45] points in the absence of ICP, p<0.05). 80.0% of these women reported sleep disorders. The incidence of significant sleep quality disturbances is 37.5%. Patients demonstrate a higher median level of both personal and situational anxiety. Manifestations of depression were noted in 55.0% patients against 27.5% in the comparison group (p<0.05). Women with ICP have lower ratings for their quality of life, both on physical and psychological health scales. The decrease in the integral indicator of physical health (70 [58; 89] versus 84 [75; 92], p<0.05) is a reflection of the physical discomfort associated with ICP. Conclusions. After using ART, women with ICP need to assess the vegetative and psychoemotional state, correct the revealed disorders to normalize the quality of life, and achieve positive perinatal outcomes. Keywords: assisted reproductive technologies, intrahepatic cholestasis of pregnancy, vegetative dysfunction syndrome, anxiety, depression, quality of life.

GlutathioneS-transferase and liver function in intrahepatic cholestasis of pregnancy and pruritus gravidarum

Hepatology ◽  
2004 ◽  
Vol 40 (6) ◽  
pp. 1406-1414 ◽  
Author(s):  
Anthony T. Dann ◽  
Anna P. Kenyon ◽  
Paul T. Seed ◽  
Lucilla Poston ◽  
Andrew H. Shennan ◽  
...  
Keyword(s):  
Liver Function ◽  
Intrahepatic Cholestasis ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Cholestasis Of Pregnancy

scholarly journals Characterization of Gut Microbiota Associated with Clinical Parameters in Intrahepatic Cholestasis of Pregnancy

2020 ◽  
Author(s):  
Rong Li ◽  
xuehai chen ◽  
Zhongzhen Liu ◽  
Yan Chen ◽  
Chuan Liu ◽  
...  
Keyword(s):  
Gut Microbiota ◽  
Pregnant Women ◽  
Intrahepatic Cholestasis ◽  
Premature Delivery ◽  
Clinical Parameters ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Control Groups ◽  
And Control ◽  
Cholestasis Of Pregnancy

Abstract Background: Intrahepatic cholestasis of pregnancy (ICP) is a liver disorder that specifically occurs in pregnancy. Elevated levels of liver transaminases aspartate aminotransferase, alanine aminotransferase and serum bilirubin levels are common biochemical characteristics in ICP. The disorder is associated with an increased risk of premature delivery and stillbirth. The characterization of the potential microbiota in ICP could go a long way in the prevention and treatment of this pregnancy disease.Methods: A total of 58 patients were recruited for our study: 27 ICP patients and 31 healthy pregnant subjects with no ICP. The V3 and V4 regions of the 16S rDNA collected from fecal samples of both diseased and control groups were amplified. 16S rRNA gene amplicon sequencing was then performed on gut microbiota. Sequencing data were analyzed and the correlation between components of microbiota and patient ICP status was found. Related metabolic pathways, relative abundance and significantly different OTUs (Operational Taxonomic Units) between ICP and controls were also identified.Results: Elevated levels of total bile acid, ALT, AST, Dbil and Tbil were recorded or observed in ICP subjects as compared to the control. Gut microbiota in pregnant women was dominated by four major phyla and 27 core genera. PCoA analysis results indicated that there was no significant clustering in Bray-Curtis distance matrices. Our results showed that there was a correlation between specific OTUs and measured clinical parameters of pregnant women. Comparison at the different taxonomy levels revealed high levels of abundance of Blautia and Citrobacter in ICP patients. At the family level, Enterobacteriaceae and Leuconostocaceae were higher in ICP patients. 638 KEGG Orthologs and 138 pathways significantly differed in the two groups; ICP patients and control group and PLS-DA model with VIP plots indicated a total of eight genera and seven species were key taxa in ICP and control groups.Conclusions: Our research indicated that although there was no significant clustering by PCoA analysis, patients with ICP have increased rare bacteria at different phylogenetic levels. Our results also illustrated that all 638 KEGG Orthologs and 136 in 138 KEGG pathways were less abundant in ICP patients compared to the controls.

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