妊娠期肝内胆汁淤积综合征终止妊娠时间与围生儿预后的关系分析

目的探讨妊娠期肝内胆汁淤积症（ICP）终止妊娠时间与围生儿预后的关系。方法对近2年来在本院住院分娩的119例ICP病例进行回顾性分析。结果按终止妊娠的时间分为≤34^＋6周、35周-、36周-、37周～、38周-、39周-、40周-7组。37周前，羊水胎粪污染率、新生儿窒息率以35周-最高，≤34^＋6-周最低，37周以后随着孕周的增加羊水胎粪污染率及新生儿窒息率逐渐增高；37周前的低体重儿发生率较高，37周及以后发生率已很低；总胆汁酸（TBA）值〉50umol／L较TBA≤50umol／L者羊水胎粪污染率明显增加，但新生儿窒息率无明显差异，76％在37周前已终止妊娠，≤34^＋6-周占12％；孕妇胆红素升高者羊水胎粪污染及新生儿窒息率明显增加，63％在37周前终止妊娠，≤34^＋6周仅占7．89％。结论TBA〉50umol／L者羊水胎粪污染率较高，胆红素升高者羊水胎粪污染率及新生儿窒息率均较高，应尽可能在37周前终止妊娠，特别是胆红素明显升高者应尽可能在35周前终止妊娠；TBA≤50umol／L且无胆红素升高者可在37周左右终止妊娠，尽量不超过38周。

Objective Discussing the relation between the gestational weeks of terminating pregnancy and the prognosis of the newborns of intrahepatic cholestasis of pregnancy（ICP） sufferers. Methods Reviewing 119 cases in our hospital in last one year and four months. Results Grouping the cases into ≤ 34^＋ 6 week group, 35week - group,36 week - group,37week - group,38week - group,39week - group,40week group by weeks of terminating pregnancy o before 37 week, the rase of meconium-staining amniotic fluid and the rase of asphyxia neonatorum in 35week -group are highest,while these are lowest in ≤34 ^＋6week group. After 37 week, the rase of meconium-staining amniotic fluid and the rase of asphyxia neonatornm gradually enhance by the gestational weeks. The rase of infant of low-birth weight borning before 37 week is superior to one borning after 37 week. Contrasted with the cases whoes total bile acid （TBA） ≤ 50 umol/L, the rase of meconium-staining amniotic fluid is obvious increase, but the rase of asphyxia neonatorum is no differentia in the cases whoes TBA 〉 50 umol/L. 76% cases terminated pregnancy before 37 week, and 12% cases are ≤ 34 ^＋6week. the rase of meconium-staining amniotic fluid and the rase of asphyxia neonatorum are obvious increase in the cases whoes bilirnbin increased. 63% cases terminated pregnancy before 37 week, and 7.89% cases are ≤ 34 ^＋6week. Conclusion The rase of meconium-staining amniotic fluid is obvious increase in the cases whoes TBA 〉 50 umol/L;the rase of meconium-staining amniotic fluid and the rase of asphyxia neonatorum are obvious increase in the cases whoes bilirubin increased so that the week of terminating pregnancy should be before 37 week, especially the cases whoes bilirubin obvious increaseed terminating pregnancy should be before 35 week. the cases whoes TBA ≤50 umol/L but normal bilirubin could terminate pregnancy in 37 week, but as far as possible not beyond 38 week.