Anaemia of pregnancy

This paper reports the findings of a cross-sectional study of anaemia in Indian and black women attending an antenatal clinic. Anaemia as defined by current World Health Organization criteria was detected in 13,2% of Indian women in the first trimester of pregnancy, in 28,1% in the second trimester and in 47,0% in the third trimester. Iron deficiency, diagnosed on the basis of low serum ferritin levels (less than 12 ng/ml), was common, the prevalence being 35% in the first trimester and rising to 86% in the third; this demonstrates the effects of the progressively increasing stress on iron metabolism as pregnancy advances. Reduced folate levels (less than 3 ng/ml) were detected in 8,8% of subjects in the first trimester and in 47% in the third. It may therefore be concluded that anaemia was common in this group and that its prevalence increased progressively as pregnancy advanced. Iron deficiency was by far the commonest type of deficiency observed. While folate levels were low in a fair proportion of subjects, evidence of coexistent iron deficiency was found in all of them. It is therefore not clear whether or not a primary nutritional deficiency of folic acid contributed towards the production of anaemia. A similar study was done among pregnant black women. Anaemia was detected in 18,8%, 26,0% and 28,6% of subjects in the three trimesters. Iron deficiency, diagnosed on the basis of low serum ferritin levels, was observed in 19% and 40% of women in the first and third trimesters respectively. Reduced folate levels were found in 8,7% of subjects in the first trimester and in 10% in the third.(ABSTRACT TRUNCATED AT 250 WORDS)     

Anaemia in pregnant Indian women in Johannesburg

A study was performed in 100 subjects to determine the prevalence and cause of anaemia in pregnant Indian women in the Johannesburg area. The geometric mean serum ferritin concentration in all three trimesters of pregnancy was below 12 micrograms/l, with 43.3% of women in the first, 48.6% in the second and 80.0% in the third trimester having concentrations below this value. Estimation of body iron stores revealed a mean deficit of 265 mg iron in subjects in the third trimester, 20% of whom had iron deficiency anaemia. No difference in iron status was demonstrable in subjects from different religious backgrounds. Folate and vitamin B12 nutrition was adequate. Three subjects were diagnosed as being beta-thalassaemia heterozygotes. The findings underline the need for routine iron supplementation of pregnant Indian women in the Johannesburg area.     

Iron and folate status of pregnant black women in Gazankulu

A limited nutritional survey was carried out in 229 first attenders at an antenatal clinic in Gazankulu during the winter of 1984. Haemoglobin concentrations equal to or less than 11 g/dl were found in 33% of these women, the prime reason being folate deficiency. Serum folate concentrations were less than a 3.5 ng/ml in 60% of subjects and less than 3.0 ng/ml in 48%. A mean corpuscular volume of 100 fl or more, which reflects a defect in red cell DNA synthesis, was present in 35%. Iron related measurements indicated that only 17% were also iron deficient but the figure is certainly an underestimate, since the presence of folate deficiency tends to mask concomitant iron deficiency. The findings underline the need for folate and iron supplementation in pregnancy; the very high prevalence of significant folate deficiency also indicates that serious consideration should be given to the fortification of maize meal with folic acid.     

Acid-base state of cerebrospinal fluid during pregnancy and its effect on spread of spinal anaesthesia

To assess the possible relationship between changes in acid-base state of cerebrospinal fluid (CSF) and enhanced spread of spinal anaesthesia during pregnancy, we have measured CSF pH, carbon dioxide tension (PCO2) and HCO3- values in 73 women undergoing spinal anaesthesia with hyperbaric amethocaine 8 mg. Patients were allocated to one of four groups according to gestational period: non-pregnant group (n = 13), first trimester group (8-13 weeks, n = 19), second trimester group (14- 26 weeks, n = 11) and third trimester group (27-39 weeks, n = 30). The pH of the CSF was greater in the second and third trimester groups than in the non-pregnant group. CSF PCO2 decreased by 0.53-0.8 kPa throughout pregnancy. CSF HCO3- was decreased throughout pregnancy. Overall, no clinically significant correlation was found between maximum cephalad spread of analgesia and CSF pH, PCO2 or HCO3-. We conclude that pregnancy-induced changes in acid-base state of CSF have little effect on the spread of spinal anaesthesia, although there is a clinically different spread of spinal anaesthesia between non-pregnant and pregnant states.      

Biphasic changes in autonomic nervous activity during pregnancy

To understand the sequential response of the autonomic nervous system to pregnancy, we studied heart rate variability in 23 first trimester, 23 second trimester and 21 third trimester pregnant women. Twenty non- pregnant women were recruited as controls. Time and frequency domain measures of heart rate variability in three recumbent positions were compared. We found that normalized high-frequency power in the supine position increased significantly in the first trimester (42.2 (95% confidence interval (CI) 5.4) nu (normalized unit); P < 0.05) compared with non-pregnant controls (33.0 (6.0) nu), and then decreased progressively in the second (27.3 (6.7) nu) and third (21.8 (6.0) nu; P < 0.05) trimesters. The low-/high-frequency power ratio in the supine position decreased significantly in the first trimester (0.8 (0.3); P < 0.05) compared with that of non-pregnant controls (1.1 (0.3)) and increased progressively in the second (1.5 (0.4)) and third (2.1 (0.8); P < 0.05) trimesters. When the position was changed from the supine to the right lateral decubitus, the percentage change in normalized high- frequency power correlated significantly and negatively with normalized high-frequency power in the supine position in non-pregnant controls (r = -0.56, P = 0.01) and in pregnant women in the first (r = -0.44, P = 0.034), second (r = -0.68, P < 0.001) and third (r = -0.68, P < 0.001) trimesters. These results indicate that autonomic nervous activity shifted towards a lower sympathetic and higher vagal modulation in the first trimester, and changed towards a higher sympathetic and lower vagal modulation in the third trimester as gestational age increased. The balance between the haemodynamic changes of pregnancy and aortocaval compression caused by the enlarging gravid uterus may be responsible for the biphasic changes in autonomic nervous activity during pregnancy.      

Study of urinary outflow in pregnancy

Anatomical and physiological changes in the urinary tract develop during pregnancy. These changes may affect the urinary outflow. Urinary symptoms may develop during pregnancy in previously asymptomatic patients. Most of these symptoms will vanish after delivery. Some of them remain and others will become worse in consecutive pregnancies. A study was designed to compare if there was any difference in the urinary outflow between pregnant and non-pregnant women. Changes in the urinary outflow at different gestacional ages were studies too. In general, the urinary volume is higher in pregnant than in non-pregnant patients. Having said this, during the pregnancy this volume decrease in the third trimester. Peak urinary outflow is higher in pregnancy, being statically significant during the second and third trimester. Opposite to the non-pregnant patient, peak urinary outflow does not decrease with urinary volumes over 500 ml in pregnant patients. Significant differences were not found in the mean urinary outflow in both groups.     

Antepartum and postpartum anemia: a narrative review

Antepartum anemia impacts over a third of pregnant women globally and is associated with major maternal and perinatal morbidity, including peripartum transfusion, maternal death, maternal infection, preterm birth, and neurodevelopmental disorders among offspring. Postpartum anemia impacts up to 80% of women in low-income and rural populations and up to 50% of women in Europe and the United States, and is associated with postpartum depression, fatigue, impaired cognition, and altered maternal-infant bonding. Iron deficiency is the most common cause of maternal anemia because of insufficient maternal iron stores at the start of pregnancy, increased pregnancy-related iron requirements, and iron losses due to blood loss during parturition. Anemic women should undergo testing for iron deficiency; a serum ferritin cutoff level of 30 μg/L is commonly used to diagnose iron deficiency during pregnancy. The first-line treatment of iron deficiency is oral iron. Intravenous iron is a consideration in the following scenarios: a poor or absent response to oral iron, severe anemia (a hemoglobin concentration <80 g/L), rapid treatment for anemia in the third trimester, women at high risk for major bleeding (such as those with placenta accreta), and women for whom red blood cell transfusion is not an option. Given the high prevalence of antepartum and postpartum anemia, anesthesiologists are advised to partner with other maternal health professionals to develop anemia screening and treatment pathways.     

Prospective hematologic evaluation of gastric exclusion surgery for morbid obesity.

To evaluate the long-term frequency and severity of anemia and selected vitamin and mineral deficiencies after gastric exclusion surgery for morbid obesity, the authors prospectively examined hematologic and nutritional parameters in 150 consecutive patients. These patients underwent a standardized gastric exclusion procedure during a six-year period (1976-1982) and were closely followed for up to seven years (mean, 33.2 months). Anemia developed in 36.8% of the population at a mean time from operation of 20 months. It was more frequent in women than in men (p less than 0.01), and it required transfusions in 3.5% of the population. A low serum iron concentration developed in 48.6%, iron deficiency in 47.2%, a low serum vitamin B12 concentration in 70.1%, vitamin B12 deficiency in 39.6%, and RBC folate deficiency in 18% of the population. Both iron and folate deficiencies responded to oral replacement. As a result of the high frequency and severity of anemia and nutritional deficiencies noted, all gastric exclusion patients should, as a minimum, be placed on oral multivitamin preparations containing iron, folate and vitamin B12. In addition, it is imperative that these patients be followed closely for the remainder of their lives with appropriate studies and replacement as necessary.     

The use of a sound-enabled device to measure pressure during insertion of an epidural catheter in women in labour

The insertion of an epidural catheter for labour analgesia may be challenging. This observational study compared pressures during insertion of an epidural catheter in pregnant (n = 35) and non-pregnant (n = 10) women, using an acoustic device for locating the epidural space that also records and stores pressure data during the procedure. In both groups, we compared the maximum pressure just before loss of resistance, the pressure in the epidural space and the pressure in the inserted epidural catheter. Maximum pressure just before loss of resistance in the pregnant women was significantly lower compared with the non-pregnant women. Pressures in the epidural space and with the disposable tubing connected to the inserted epidural catheter were greater in pregnant women than in non-pregnant women. The results support the hypothesis that physiological changes in the third trimester of pregnancy are the reason why epidural catheters are more difficult to insert in women in labour.     

Spread of subarachnoid hyperbaric amethocaine in pregnant women

In order to examine how the gestational period influences thespread of spinal anaesthesia, we have measured the extent ofspinal block produced by hyperbaric amethocaine 8 mg in 90 women.The patients were allocated to one of five groups accordingto the gestational period: non-pregnant group (n = 17), firsttrimester group (6–12 weeks, n = 14), second trimestergroup (13–24 weeks, n = 26), third trimester group (25–36weeks, n = 15) and term group (37–41 weeks, n = 18). Maximumcephalad spread of analgesia was significantly higher in thesecond trimester (median T3 (range T9–C6)), third trimester(T3 (T4–C7)) and term groups (T2.5 (T4–C8)) thanin the non-pregnant (T4 (T8–T2)) and first trimester groups(T4 (T11–C7)). We found that not only term pregnancy butalso second and third trimester pregnancies enhanced the spreadof spinal anaesthesia, and that first trimester pregnancy didnot affect the spread of spinal anaesthesia.     

Cerebrospinal fluid progesterone in pregnant women

To assess the possible relationship between an increase in progesterone concentration in cerebrospinal fluid (CSF) and enhancement of spread of spinal anaesthesia, we have measured CSF progesterone concentrations in 134 patients undergoing spinal anaesthesia with hyperbaric amethocaine 8 mg. Patients were allocated to one of five groups according to the gestational period: non-pregnant group (n = 13), first trimester group (8-12 weeks, n = 16), second trimester group (13-24 weeks, n = 18), third trimester group (25-36 weeks, n = 38) and term group (37-41 weeks, n = 49). Progesterone concentration in CSF was higher in the third trimester and term groups than in the non-pregnant, first trimester and second trimester groups. Maximum cephalad spread of analgesia was higher in the second trimester, third trimester and term groups than in the non-pregnant and first trimester groups. Although an increase in CSF progesterone concentration in the second trimester group was similar in magnitude to that observed in the first trimester group, enhanced spread of spinal anaesthesia, comparable in magnitude with that observed in the term group, occurred in the second trimester group. There was no significant correlation between CSF progesterone concentration and spread of spinal anaesthesia in any of the groups. These data suggest that not only a minimum level of progesterone in CSF but also a certain duration of exposure to elevated CSF progesterone concentrations may be necessary for enhancement of spread of spinal anaesthesia, and that values of CSF progesterone concentration do not correlate directly with enhancement of spread of spinal anaesthesia.      

Increase of body iron stores estimated by the increase of serum ferritin concentration during a treatment of 200 mg Fe++ daily after gastrointestinal surgery

A 6-week iron therapy of 200 mg Fe++ daily was given to 13 men and 12 women who had previously undergone various kinds of common gastrointestinal surgery and who had empty iron stores estimated from low serum ferritin concentration. The results were compared with those of a control group corresponding to the study group in respect of sex, number of patients, primary disease, previous operation, empty iron stores (serum ferritin), blood hemoglobin, serum iron, sedimentation rate, blood leukocytes, serum transferrin, folate and vitamin B12. The iron therapy restored the lack of body iron, for the serum ferritin concentrations increased from 12 +/- 7 to 30 +/- 11 micrograms/l (p less than 0.001) in the men and from 10 +/- 6 to 30 +/- 12 micrograms/l (p less than 0.001) in the women, whereas the corresponding changes in the control group were from 10 +/- 9 to 11 +/- 8 micrograms/l and from 11 +/- 8 to 13 +/- 11 micrograms/l in the men and women, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)     

髓源性抑制细胞在妊娠过程中的变化及作用

目的探索髓源性抑制细胞(MDSC)在妊娠过程中的变化以及免疫抑制作用,为母胎免疫耐受调控提供理论基础。方法选取2014年1~12月在我院行产检的正常妊娠妇女共106例作为研究对象,孕早、中、晚期孕妇分别为24、29、32例,产妇21例。对照组为于我院行孕前检查的正常妇女,无流产史及其他基础疾病,共34例。分别采集孕早期、中期、晚期外周血以及产妇生产时外周血、脐带血、胎盘以及蜕膜组织、产后24h外周血进行检测。孕早、中、晚期孕妇分别为24、29、32例,产妇为21例。对照组为于我院行孕前检查的正常妇女,无流产史及其他基础疾病,共34例。采用流式细胞仪技术检测MDSC的比例,分析MDSC的变化。采用流式分选、纯化后的MDSC,与CD3+T细胞共培养,通过分析[3 H]胸(腺嘧啶脱氧核)苷密度分析T细胞增殖能力。结果妊娠妇女外周血MDSC的比例(6.25±3.59)%显著高于未妊娠正常女性(1.70±0.77)%(P0.01),而孕中期外周血MDSC比例(10.43±7.22)%显著高于孕早期(3.88±1.67)%、晚期(5.25±1.91)%(P0.01);分娩后,外周血MDSC比例(1.81±1.08)%下降至妊娠前水平。脐带血、蜕膜以及胎盘组织中MDSC的比例也维持在较高水平,脐带血MDSC比例(17.15±6.00)%显著高于蜕膜(8.65±3.67)%及胎盘(7.66±3.73)%(P0.01)。MDSC显著抑制外周血CD3+T细胞增殖能力(P0.01)。结论 MDSC可能参与了母胎免疫耐受的调节,抑制母体免疫排斥反应,有利于妊娠继续维持。     

Vitamin K1 monitoring in pregnancies after bariatric surgery: a prospective cohort study

BackgroundNeonatal intracranial bleedings and birth defects have been reported, possibly related to maternal vitamin K1 deficiency during pregnancy after bariatric surgery. The objective of this study was to investigate the effects of screening and supplementation on K1 serum levels in pregnant women with bariatric surgery, and to compare K1 levels and prothrombin time (PT %) in the first trimester with pregnant women without bariatric surgery.MethodsA prospective cohort study including 49 pregnant women with bariatric surgery. Nutritional deficiencies were prospectively screened. In case of observed low K1 serum levels, supplementation was provided. K1 serum levels and PT (%) during the first trimester were compared with a nonsurgical control group of 27 women.ResultsDuring the first trimester, most women had low K1 serum levels (<0.8 nmol/l). Mean vitamin K1 levels were significantly lower in the surgical group compared to the nonsurgical control group (.44 versus .64 nmol/l; P = .016). PT (%) remained in the normal range, The surgery group showed a higher mean PT compared to the controls (111.3 versus 98.9%; P<.001) Mean K1 serum levels in the study group were higher during the third than during the first trimester (P = .014). PT (%) was significantly higher during the second and third than during the first trimester (P = .004). Most of the coagulation factors, including II, V, VII, IX, and X, remained within normal ranges.ConclusionLow circulating K1 appears to be common in pregnant women with and without bariatric surgery. Supplementation during pregnancy can restore vitamin K1 in women with bariatric surgery, potentially protecting the fetus and newborn against intracranial hemorrhage.     

Delay in treatment of biliary disease during pregnancy increases morbidity and can be avoided with safe laparoscopic cholecystectomy.

Recent reports indicate that laparoscopic cholecystectomy in pregnancy is safe. The aim of this study was to evaluate whether delays in definitive treatment of symptomatic cholelithiasis increase morbidity. We reviewed the records of 16 women who underwent laparoscopic cholecystectomy during pregnancy between 1992 and 1999. Mean age was 24 +/- 5 years (mean +/- standard error). Symptom onset was during the first trimester in nine patients, second trimester in six patients, and third trimester in one patient. Patients had abdominal pain (93%), nausea (93%), emesis (80%), and fever (66%) for a median of 45 days (range 1-195 days) before cholecystectomy. Nine of 11 women who underwent cholecystectomy more than 5 weeks after onset of symptoms experienced recurrent attacks necessitating 15 hospital admissions and four emergency room visits. Moreover four women who developed symptoms in the first and second trimesters but whose operations were delayed to the third trimester had 11 hospital admissions and four emergency room visits; three of those four (75%) women developed premature contractions necessitating tocolytics. Cholecystectomy was completed laparoscopically in 14 women. There was no hospital infant or maternal mortality or morbidity. We recommend prompt laparoscopic cholecystectomy in pregnant women with symptomatic biliary disease because it is safe and it reduces hospital admissions and frequency of premature labor.     

The effect of pregnancy on kidney function in renal allograft recipients

In women with renal transplants glomerular filtration rate (GFR) increases during pregnancy but how soon the increment occurs, its relation to pre-pregnancy GFR, and the overall pattern of change are unknown. Twenty-four hour creatinine clearance (24-hr CCr) were measured prospectively in ten pregnancies in eight allograft recipients before conception, throughout pregnancy, 8 to 12 weeks postpartum, and 4 to 6 monthly thereafter. Inulin (CIn) in creatinine (CCr) clearances during infusion were also determined and protein excretion was evaluated. The results were compared to those in similar studies in ten healthy women. By the tenth gestational week 24-hr CCr was 124 +/- (SD) 15.9 ml/min in healthy women (an increase of 38%; range, 18 to 69%) and in transplant patients was 105 +/- 28.1 ml/min (an increase of 34%: range, 10 to 60%), with the greatest increments in those whose allografts functioned best before conception, regardless of donor source and sex or the transplant-pregnancy interval. In late pregnancy mean 24-hr CCr decreased by 19% (range, 6 to 28%) in healthy women and by 34% (range, 12 to 57%) in the transplant patients, but in most this did not represent graft deterioration nor lead to permanent impairment. At all time points CIn values were 5 to 10% greater than those for 24-hr CCr but slightly less than infusion CCr values. Protein excretion increased throughout pregnancy and by the third trimester in healthy women averaged 200 mg in 24 hr and regularly exceeded 500 mg in 24 hr in transplant patients, which was three times non-pregnant levels and probably not clinically significant.(ABSTRACT TRUNCATED AT 250 WORDS)     

Are vitamin B12 and folate deficiency clinically important after roux-en-Y gastric bypass?

Although iron, vltamm B₁₂, and folate deficiency have been well documented after gastric bypass operations performed for morbid obesity, there is surprisingly little information on either the natural course or the treatment of these deficiencies in Roux-en-Y gastric bypass (RYGB) patients Durmg a l0-year period, a complete blood count and serum levels of iron, total iron-binding capacity, vltamin B₁₂, and folate were obtained in 348 patients preoperatively and postoperatively at 6-month intervals for the first 2 years, then annually thereafter The principal objectives of this study were to determine how readily patients who developed metabolic deficiencies after Roux-en-Y gastric bypass responded to postoperative supplements of the deficient micronutrient and to learn whether the risk of developmg these deficiencies decreases over time Hemoglobin and hematocrit levels were slgnificantly decreased at all postoperative intervals in comparison to preoperative values Moreover, at each successive interval through 5 years, hemoglobin and hematocrit were decreased signifiantly compared to the preceding interval Folate levels were significantly increased compared to preoperative levels at all time intervals Iron and vltamin B₁₂ levels were lower than preoperative measurements and remained relatively stable postoperatively Half of the low hemoglobin levels were not associated with iron deficiency Taking multivltamin supplements resulted in a lower incidence of folate deficiency but did not prevent iron or vitamin B₁₂ deficiency Oral supplementation of iron and vitamin B₁₂ corrected defiaencies in 43% and 81% of cases, respectively Folate deficiency was almost always corrected with multivitamins alone No patient had symptoms that could be attributed to either vitamin B₁₂ or folate deficiency Conversely, many patients had symptoms of iron deficiency and anenua Lack of symptoms of vitamin B₁₂ and folate deficiency suggests that these deficiencies are not clinically important after RYGB Conversely, iron deficiency and anemia are potentially serious problems after RYGB, particularly in younger women Hence we recommend prophylactic oral iron supplements to premenopausal women who undergo RYGB     

Primary hyperparathyroidism during pregnancy.

Historically, primary hyperparathyroidism during pregnancy was associated with significant risk of maternal morbidity and fetal death. Maternal hypercalcemia results in fetal hypercalcemia, leading to suppression of fetal parathyroid gland function. Neonatal hypocalcemia with tetany is a common occurrence after birth when maternal calcium flow is interrupted. From 1930 to 1990, 109 cases of women with primary hyperparathyroidism associated with pregnancy have been reported, 39 of whom were treated surgically before delivery. Although fetal mortality rates for medically treated women have improved, fetal morbidity continues to remain higher than in women who undergo surgical treatment of parathyroid disease during pregnancy. Of 850 patients treated surgically for primary hyperparathyroidism since 1960, 12 were pregnant. Four of the patients were treated medically during pregnancy and underwent surgery after delivery; all four infants had neonatal hypocalcemia and tetany. The remaining eight patients were treated surgically during pregnancy: six in the second trimester and two (one with associated pancreatitis and one with hypercalcemic crisis) during the first trimester. There was no fetal or maternal morbidity or death in the surgical group. Parathyroid adenomas were present in 10 of the patients, hyperplasia in one, and parathyroid carcinoma in one. The management of maternal primary hyperparathyroidism diagnosed during pregnancy should be based on the patient's symptoms and severity of disease. Hyperparathyroidism characterized by progressive symptoms should be treated surgically, preferably during the second trimester. Symptom-free patients and those with mild hypercalcemia diagnosed in the third trimester may be managed medically, postponing operation until after delivery.     

Management of pregnancy-associated breast cancer

Breast cancer during pregnancy remains a challenge for clinicians and a difficult experience for women and the families. Any breast symptom during pregnancy warrants triple assessment and any lump should have a definite diagnosis. If cancer is diagnosed it is usually possible to continue with the pregnancy without compromising any of the treatment modalities (except radiotherapy). The outcome for women diagnosed with breast cancer during pregnancy is the same as for age and stage-matched non-pregnant counterparts. There is no evidence of adverse foetal outcome if chemotherapy is given during the second or third trimester. However, the reported series are relatively small and more systematic long-term follow-up is needed.     

内镜逆行胰胆管造影术治疗妊娠合并急性胆管炎

目的探讨内镜下逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)治疗妊娠合并急性胆管炎的效果及安全性.方法对本院2001年8月至2009年2月采用ERCP联合乳头切开术(endoscopic sphincterotomy,EST)治疗的16例妊娠合并急性胆管炎患者的临床资料进行回顾性分析.结果2例于妊娠3个月(妊娠早期)时行ERCP术+塑料内支架引流,未行EST取石,分别于术后4个月和5个月后内支架堵塞,再次行EST术取石.8例妊娠中期病例,7例一次性EST取净结石;1例因胆总管有多枚结石,行EST部分取石后放置塑料内支架,分娩后2周再行ERCP术取净结石.6例妊娠末3个月患者,5例1次行EST术取石成功;1例造影见胆总管结石多枚,直接放置塑料内支架1根引流,分娩1个月后,再行ERCP术取净结石.1例妊娠末3个月患者术后并发急性轻型胰腺炎,经治疗后痊愈;其余病例无术后并发症发生.全部病例随访至胎儿出生后1个月,未发现早产和宫内胎儿窘迫病例,无畸形、发育迟缓、智力低下儿出生.结论短期随访显示,ERCP治疗妊娠合并急性胆管炎安全有效.但目前尚缺乏射线对胎儿是否有影响的长期随访结果.