妊娠肝内胆汁瘀积症对母儿的危害分析

为探讨妊娠肝内胆汁瘀积症（ＩＣＰ）对母儿的影响，对１９８９～１９９６年在我院住院分娩的４７１例ＩＣＰ患者的症状、肝功及妊娠结局进行了回顾性分析。结果：搔痒出现孕周平均３２．４±４．７周（１２～４０周）；早产率１６．６％（７８例）；围产儿死亡率１２．７‰（６例）；羊水Ⅱ°～Ⅲ°１１４例（２４．２％）；分娩方式（自然产＝１，阴道助产＝２，剖宫产＝３）与新生儿Ａｐｇａｒ评分呈正相关（ｒ＝０．１１８８，Ｐ＜０．０５）；３０～３３＋６周组羊水性状明显比３７周组差（０．８９±１．１１比０．５５±０．９６，Ｐ＜０．０５）；血总胆红素＞３４μｍｏｌ／Ｌ组羊水性状明显比１７．１～３４μｍｏｌ／Ｌ组差（０．９６±１．１１比０．６５±１．０４，Ｐ＜０．０５）；血总胆汁酸＞４０μｍｏｌ／Ｌ组羊水性状比正常组（≤２０μｍｏｌ／Ｌ）差（０．８９±１．１比０．３３±０．８８，Ｐ＜０．０５）。由此提示：搔痒出现孕周的提前（３０～３６＋６周）、血总胆红素及总胆汁酸的增加可作为ＩＣＰ程度划分的指标，适时的剖宫产可以提高新生儿Ａｐｇａｒ评分。

The Maternal-Fetal Harm Study of Intrahepatic Cholestasis of Pregnancy

The aim of this study was to assess the harm of intrahepatic cholestasis of pregnancy (ICP) to the mother and fetus. The symptoms, liver function and outcome of 471 cases of ICP in our hospital during 19891996 were studied retrospectively. The mean pregnant weeks when pruritus first came on was 32.44.7(1240) weeks.the incidence of preterm delivery 16.6% (78 cases); the perinatal mortality 12.7 (6 cases). The incidence of the cases associated with amnion fluid (n=108) was 24.2%. The relationship between the mode of delivery (natural labor=1,forceps delivery=2,cesarean section=3) and newborn Apgar scores was positive (r=0.1188,P<0.05).The amniotic fluid status in the group of 3033 6 pregnant weeks was significantly worse than that in the group of term pregnancy (0.891. 11 vs 0.550.96,P<0.05).The amniotic fluid status in the group with serum total bilirubin >34 mol/L was worse than that in the 17.134 mol/L group (0.9611 vs 0.65104,P<005), and that in the group with serum total bile acid concentration >4 0 mol/L was worse than that in the serum total bile acid normal group (20 mol/L) (0.891.1 vs 0.330.8,P<0,05).Our results suggest that the severity of ICP may be indicated by early onset of prutitus (3036 6 pregnant weeks),the rising of serum total bilirubin level and the increasing of total bile acid concentration, and based on these indicators, timely cesarean section may increase the newborn Apgar scores.