妊娠肝内胆汁淤积症1210例围生结局分析

目的探讨妊娠肝内胆汁淤积症(ICP)的围生结局。方法对近10年在我院产前检查并住院治疗分娩的1210例ICP病例资料进行回顾性分析。结果ICP先兆早产率19.0%(230/1210),88.7%(204/230)发生于32周后,先兆早产住院病例发生死胎占所有ICP死胎的46.7%(7/15);ICP早产率24.0%(290/1210),96.2%(279/290)分布于34周以后,89.7%(260/290)为胎儿异常行剖宫产;羊水胎粪污染率23.2%(281/1210),41.3%(116/281)发生于临产前,羊水胎粪污染对新生儿窒息(新生儿1 m in Apgar评分≤7分)预测率为25%(70/281);新生儿窒息发生率7.1%(86/1210);围生儿病死率22.5‰(27/1210),其中死胎占56%(15/27),死胎平均孕周36.5周±1.2周,80%(12/15)发生于妊娠35周后,所作胎心监护均无异常发现,95%(19/20)的死胎、死产突然发生于先兆早产、偶然宫缩或临产初期;剖宫产率85.9%(1039/1210),胎儿生长受限(FGR)发生率0.9%(11/1210),产后出血率1.4%(17/1210),8.1%(101/1210)ICP患者合并子痫前期。结论ICP胎儿无明显FGR表现,子痫前期及产后出血发生率与一般孕妇人群相似;常规胎儿监护手段难以预测ICP死胎;积极防治先兆早产,重视先兆早产、偶然宫缩、产前羊水胎粪污染或临产初期时的胎儿监护,把握终止妊娠时机(34~37周),是降低ICP围生儿病死率的重要手段。

Perinatal outcomes of intrahepatic cholestasis of pregnancy: analysis of 1210 cases

OBJECTIVE: To study the perinatal outcomes of intrahepatic cholestasis of pregnancy (ICP). METHODS: The clinical data of 1210 cases of ICP in recent ten years were retrospectively analyzed. RESULTS: The incidence rates of perinatal outcomes of ICP were as follows: 19.0% (230/1210) for threatened premature labor, 24.0% (290/1210) for premature delivery; 23.2% (281/1210) for meconium stained amniotic fluid, 7.1% (86/1210) for neonatal asphyxia, 22.5 per thousand (27/1210) for perinatal mortality, 85.9% (1039/1210) for cesarean section, 0.9% (11/1210) for fetal growth restriction (FGR), 1.4% (17/1210) for postpartum hemorrhage, and 8.1% (101/1210) for preeclampsia. Threatened premature labor occurred beyond the gestation gestation period of 32 weeks in 88.7% (204/230) of the patients, and the fetal death rate in threatened premature labor was 46.7% (7/15). Premature delivery occurred after 34 weeks of gestation in 96.2% of the patients (279/290) 89.7% (260/290) of which were caused by cesarean section because of abnormal fetal monitoring. 41.3% of the cases with meconium stained amniotic fluid (116/281) occurred before the onset of labor. Fetal death accounted for 56% (15/27) of perinatal death, 80% (12/15) of which happened after the gestation week of 35 (36.5 +/- 1.2) with normal fetal heart rate monitoring. 95% (19/20) of the fetal death and stillbirth occurred after threatened premature labor and occasional uterine contractions, or at the early stage of labor. CONCLUSION: The rates of FGR, postpartum hemorrhage, and preeclampsia in ICP are almost the same as those of the normal pregnancy. Routine fetal heart rate monitoring methods cannot predict fetal death. The important measures to decrease the perinatal mortality include paying attention to fetal monitoring when threatened premature labor, occasional uterine contractions and prenatal meconium occur, and at the early stage of labor, and management of threatened premature labor and timely intervention of pregnancy (at the gestation period of 34 - 37 weeks).