171例妊娠期肝内胆汁淤积症临床分析

Clinical analysis of 171 cases of intrahepatic cholestasis during pregnancy

目的分析妊娠期肝内胆汁淤积症(ICP)产妇的临床资料,探讨不同程度ICP产妇的分娩方式。方法选取住院并分娩的产妇20388例进行回顾性分析,其中诊断为ICP 171例,占比为0.84%。分析ICP产妇的临床资料。结果171例ICP产妇中,轻度ICP 142例,重度ICP 29例。142例轻度ICP孕妇中阴道分娩115例,其中羊水胎粪污染20例(17.39%);剖宫产27例,其中羊水胎粪污染3例(11.11%);阴道分娩和剖宫产产妇羊水胎粪污染发生率比较,差异无统计学意义(P>0.05)。29例重度ICP孕妇中阴道分娩19例,其中羊水胎粪污染12例(63.16%);剖宫产10例,其中羊水.胎粪污染1例(10.0%);阴道分娩与剖宫产产妇的羊水胎粪污染发生率比较,差异有统计学意义(χ2=7.485,P=0.006)。结论ICP终止妊娠的时机及方式应遵循个体化综合评价原则,严密监测胎儿宫内情况,选择合适的孕周及方式终止妊娠,可明显改善母儿妊娠结局。轻度ICP产妇可在严密监测下阴道试产,但对于重度ICP产妇或已高度怀疑胎儿窘迫或存在其他阴道分娩禁忌证者,应行剖宫产终止妊娠,避免母儿不良结局。

Objective To analyze the clinical data of puerperae with intrahepatic cholestasis of pregnancy(ICP),and to explore the delivery mode of pregnant women with diferent degrees of ICP.Methods 20388 puerperae who were hospitalized and delivered were retrospectively analyzed.Among them,171 cases(0.84%)were diagnosed as ICP.The clinical data of ICP puerperae were analyzed.Results Among 171 cases of ICP,142 cases were mild ICP and 29 cases were severe ICP.Among 142 cases of mild ICP,115 cases delivered vaginally,and 20 cases(17.39%)had meconium contamination of amniotic fuid.There were 27 cases of cesarean section,including 3 cases(11.11%)with meconium contamination of amniotic fluid.There was no significant difference in the incidence of meconium contamination in amniotic fuid between vaginal delivery and cesarean section(P>0.05).Among 29 cases of severe ICP,19 cases delivered vaginally,among which 12 cases(63.16%)had meconium contamination of amniotic fluid.There were 10 cases of cesarean section,among which 1 case(10.00%)had meconium contamination of amniotic fluid.There was a significant difference in the incidence of meconium contamination in amniotic fluid between vaginal delivery and cesarean section(χ2=7.485,P=0.006).Conclusion The timing and mode of pregnancy termination in ICP puerperae should follow the principle of individual comprehensive evaluation,closely monitor the fetal situation in utero,and choose the appropriate gestational age and mode of pregnancy termination,which can significantly improve the maternal and infant pregnancy outcome.Vaginal trial labor can be performed in patients with mild ICP under close monitoring,but for puerperae with severe ICP or with high suspicion of fetal distress or other contraindications of vaginal delivery,cesarean section should be performed to terminate pregnancy to avoid adverse maternal and infant outcomes.