妊娠期肝内胆汁淤积症发生死胎的临床分析

Clinical analysis of fetal death cases in intrahepatic cholestasis of pregnancy

目的 探讨妊娠期肝内胆汁淤积症（ICP）孕妇发生死胎的临床表现、实验室指标及胎儿监护措施和治疗手段.方法 回顾性分析2005年1月～2012年12月我院收治的2157例ICP患者中9例发生死胎的病例资料.结果 ICP死胎发生率0.42%,9例死胎均发生于妊娠晚期,孕妇均有皮肤瘙痒,9例死胎中8例为重度ICP,常规胎监多为正常,死胎外观无异常.结论 ICP孕妇发生死胎的孕周常在孕晚期,常常突然发生,难以预测.规律或不规律的宫缩可能是导致胎儿死亡的重要诱因,重度ICP发生死胎的可能性更大.因此,对已确诊的ICP患者,应加强治疗及胎儿监护,慎重对待宫缩情形,适时终止妊娠,降低死胎的发生.

Objective To investigate the clinical features, laboratoray parameters, and fetal monitoring methods and ther- apeutic measures in intrahepatic eholestasis of pregnancy （ICP）. Methods Retrospective analysis of 9 cases of ICP ending in fe- tal death among the 2157 cases treated in our hospital from January 2005 to December 2012. Results The ratio of fetal deaths to the ICP cases is 0.42%, and all the 9 ICP fetal deaths occurred during the advanced stage of pregnancy, and 8 out of the 9 preg- nant women of fetal death suffered from serious ICP, while in all the 9 cases pruritus on the pregnant women＇s body was observed, but no abnormality either in fetal surveillance or in the exterior appearance of the dead fetuses was observed. Conclusion Fetal death in ICP usually occurs in the advanced stage of pregnancy, and often abruptly, leaving little chance for prediction. With reg- ular or irregular uterine contraction as a major predisposition, fetal death is more likely in serious ICP cases. Therefore, after defi- nite diagnosis, therapeutic measures on ICP patients and fetal monitoring should be enhanced, and uterine contraction, once de- tected, should be prudently treated, and timely termination of pregnancy should be adopted in order to reduce fetal death rate.