Intrahepatic Cholestasis of Pregnancy and Neonatal Respiratory Distress Syndrome

Zecca, Enrico; Luca, Danièle De; Marras, Marco; Caruso, Alessandro; Bernardini, Tommaso; Romagnoli, Costantino

doi:10.1542/peds.2005-1801

Cited by 97 publications

(78 citation statements)

References 17 publications

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“…The present study presents an association between severe ICP and meconium-stained amniotic fluid, admittance to NICU and higher rate of global neonatal morbidity. Some studies suggest that the severity of maternal cholestasis may influence surfactant production, which could be related to the increased rates of neonatal respiratory distress [19,20,21]. …”

Section: Discussionmentioning

confidence: 99%

Clinical Value of Maternal Bile Acid Quantification in Intrahepatic Cholestasis of Pregnancy as an Adverse Perinatal Outcome Predictor

Garcia-Flores

Cañamares

Cruceyra

et al. 2015

Gynecol Obstet Invest

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Aims: To evaluate the correlation between perinatal outcome and bile acid levels in intrahepatic cholestasis of pregnancy (ICP), and to evaluate variations in the mean bile acid level when stratifying by maternal and perinatal factors. A comparison between mild and severe ICP was made. Methods: A prospective observational study was performed in pregnant patients who underwent blood tests for bile acids due to persistent pruritus. Based on bile acid levels, maternal and neonatal data were obtained and were compared between patients presenting with ICP and gestational pruritus (normal bile acid level). Results: A total of 145 patients were included, 47 of whom were diagnosed as ICP (52 newborns) and 98 as gestational pruritus (102 newborns). The ICP group had a higher rate of NICU admission (14/42 vs. 6/98, p < 0.001) and global neonatal morbidity (13/42 vs. 9/98, p = 0.002), but these differences were no longer seen after adjusting for gestational age, singleton pregnancies and induction of labour. Patients presenting with severe ICP (maximum bile acids levels above 40 µmol/l) showed a higher rate of meconium-stained amniotic fluid (0/28 vs. 4/14, p = 0.009), NICU admission (9/34 vs. 11/17, p = 0.01) and neonatal global morbidity (5/32 vs. 8/17, p = 0.02). Conclusions: ICP patients have higher rates of adverse neonatal outcomes when compared to those with gestational pruritus. Some of this neonatal morbidity may be secondary to late spontaneous preterm deliveries, multiple gestation and a policy of elective induction of labour after 37 weeks of gestation. A comparison of outcomes among patients with mild and severe ICP shows that the severely affected group has higher rates of meconium-stained amniotic fluid and neonatal morbidity.

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Section: Discussionmentioning

confidence: 99%

Clinical Value of Maternal Bile Acid Quantification in Intrahepatic Cholestasis of Pregnancy as an Adverse Perinatal Outcome Predictor

Garcia-Flores

Cañamares

Cruceyra

et al. 2015

Gynecol Obstet Invest

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“…The rate of spontaneous birth is increased with elevated bile acid levels. The rate of this complication was significantly higher in ICP pregnancies with maternal fasting serum bile acids > 40 µmol/L in a large Swedish study [57].RDS was found to affect 28.6% of newborns from cholestatic pregnancies and high levels of bile acids were found in the bronchoalveolar fluid of 10 infants with RDS [58].This can a result of prematurity but it seems as an effcet of high bile acids on fetal lung and airways. The pathophysiology of fetal death in ICP is poorly understood, but may be related to the sudden development of a fetal arrhythmia or vasospasm of the placental chorionic surface vessels induced by high levels of bile acids [59].Intrauterine demise incidence is declined recently with active management of patients with ICP.…”

Section: Fetal Outcome and Prognosismentioning

confidence: 94%

Management of Intrahepatıc Cholestasıs of Pregnancy: Revıew of Lıterature

2016

ARC Journal of Gynecology and Obstetrics

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“…Although ICP has a fairly benign course for the mother, fetal outcomes can be devastating. It is a known cause of prematurity, meconium staining of amnionic fluid, fetal respiratory distress, and stillbirth [79]. Originally reported in 1883 by Ahlfeld [80] in Germany and later by Eppinger [81] and Thorling [82], this liver derangement remains poorly understood and underreported.…”

Section: Intrahepatic Cholestasis Of Pregnancymentioning

confidence: 99%

Pregnancy-Associated Liver Disorders

Hepburn

2008

Dig Dis Sci

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Liver disorders associated with pregnancy include hyperemesis gravidarum (HG), intrahepatic cholestasis of pregnancy (ICP), preeclampsia, syndrome of hemolysis, elevated liver enzymes and low platelets (HELLP), and acute fatty liver of pregnancy (AFLP). These conditions are relatively common and unique to pregnancy and are more likely to occur at certain terms of gestation specific to each condition. They can be associated with significant maternal and fetal morbidity and mortality. Although managing such patients may be very challenging, spontaneous resolution of the disease occurs shortly after termination of the pregnancy, usually without hepatic sequellae. Early diagnosis and timely treatment is a key to therapeutic success. This article explores the clinical features, pathophysiology, and management of these disorders.

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Intrahepatic Cholestasis of Pregnancy and Neonatal Respiratory Distress Syndrome

Abstract: Maternal ICP is significantly associated with the occurrence of RDS in the newborn. We hypothesize that bile acids can produce surfactant depletion in the alveoli reverting the reaction of phospholipase A2. This hypothesis could potentially be confirmed by bronchoalveolar lavage study.

Cited by 97 publications

References 17 publications

Clinical Value of Maternal Bile Acid Quantification in Intrahepatic Cholestasis of Pregnancy as an Adverse Perinatal Outcome Predictor

Clinical Value of Maternal Bile Acid Quantification in Intrahepatic Cholestasis of Pregnancy as an Adverse Perinatal Outcome Predictor

Management of Intrahepatıc Cholestasıs of Pregnancy: Revıew of Lıterature

Pregnancy-Associated Liver Disorders

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