妊娠期肝内胆汁淤积症患者的分娩方式探讨

目的研究妊娠期肝内胆汁淤积症(intrahepatic cholestasis of pregnancy,ICP)患者的分娩方式及妊娠结局。方法选取152例ICP孕妇为研究对象,分为轻度组83例,重度组69例;随机抽取80例同期经阴道分娩的正常孕妇为对照组,比较妊娠结局。结果经阴道分娩产妇胎儿窘迫、新生儿窒息及围生儿死亡发生率重度ICP组高于轻度ICP组和对照组(P0.05);轻度ICP组与对照组围生儿不良结局比较,差异无统计学意义(P0.05)。轻度ICP组阴道分娩与剖宫产分娩者比较,羊水粪染及新生儿窒息率差异无统计学意义(P0.05),剖宫产产妇产后出血率高于阴道分娩产妇(P0.05)。结论轻度ICP患者可适当延长孕周,待产程发作后严密监测下经阴道试产,重度ICP适时剖宫产终止妊娠。

Study on delivery modes of patients with intrahepatic cholestasis of pregnancy

Objective To research the delivery modes and outcomes of patients with intrahepatic cholestasis of pregnancy（ICP）. Methods 152 pregnant women with ICP were selected and divided into mild ICP group with 83 cases and severe ICP group with 69 cases. 80 normal pregnant women with vaginal delivery were randomized chosen as control group, the delivery outcomes of the three groups were compared. Results The fetal distress, neonatal asphyxia and perinatal mortality of vaginal delivery cases in severe ICP group were higher than mild ICP group and control group （ P 〈 0. 05 ） , no significant difference in perinatal adverse outcomes were found between mild ICP group and control group（ P 〉 0. 05）. Comparing with the vaginal delivery cases and the cesarean section cases in mild ICP, no significance difference were found in meconium stained amniotic fluid and neonatal asphyxia rate （ P 〉 O. 05 ）, while postpartum hemorrhage rate in cesarean section cases was higher than vaginal deliver （ P 〈 0. 05 ）. Conclusion Patients with mild ICP may be appropriate to extend the gestational weeks and take vaginal delivery by closely monitor after the onset of labor. Patients with severe ICP may take cesarean section at an appropriate time.