一例辅助生殖术后双胎妊娠并发早发型重度妊娠期肝内胆汁淤积症的病例分析

A case analysis of early-onset of severe intrahepatic cholestasis of pregnancy in patients with twin pregnancy after IVF-ET

本文通过分析1例妊娠8周的早发型重度妊娠期肝内胆汁淤积症患者的疾病发生原因及高危因素,权衡利弊调整治疗药物,观察降低胆汁酸药物与护肝药物在妊娠早期应用的有效性和对胎儿的安全性,监护药物不良反应及药物相互作用。探讨早发型重度妊娠期肝内胆汁淤积症与辅助生殖技术中使用黄体酮注射液的关系,以及如何选择治疗早发型重度妊娠期胆汁淤积症的药物并进行药学监护。黄体酮注射液在辅助生殖技术中的使用可能会引起早发型重度妊娠期肝内胆汁淤积,停止使用黄体酮注射液,在首选治疗药物丁二磺酸腺苷蛋氨酸过敏的情况下,联合使用熊去氧胆酸和多烯磷脂酰胆碱及甘草酸制剂对妊娠8周重度妊娠期肝内胆汁淤积有一定效果,且未发现明显不良反应。

By analyzing the causes and high-risk factors of a case of early-onset severe intrahepatic cholestasis of pregnancy at 8 weeks of gestation,we balanced the advantages and disadvantages of adjusting the therapeutic drugs, observed the effectiveness of reducing bile acid drugs and hepatoprotective drugs in early pregnancy and the safety in fetuses, and monitored the adverse drug reactions and drug interactions. we explored the relationship between early-onset severe intrahepatic cholestasis of pregnancy and the use of progesterone injection in assisted reproductive technology, and how to select drugs for early-onset severe intrahepatic cholestasis of pregnancy and carry out pharmaceutical care. It was found that the use of progesterone injection in assisted reproductive technology might cause early-onset severe intrahepatic cholestasis in pregnancy. We stopped using progesterone injection and used ursodeoxycholic acid,polyenephosphatidylcholine and glycyrrhizic acid in combination with adenosylmethionine succinate as the first choice for treatment of severe intrahepatic cholestasis of pregnancy at 8 weeks of gestation,which achieved some effects, and no obvious adverse reaction was found.