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Cholestasis pregnancy timing delivery

Valérie Benhammou, Roland Tubiana, Sophie Matheron, Pierre Sellier, Laurent Mandelbrot, Jérôme LE Chenadec, Emmanuelle Marel, Babak Khoshnood, Josiane Warszawski
BACKGROUND: Chronic HBV or HCV infection is frequent in HIV- infected persons but their impact on pregnant HIV-infected women is understudied. We explored whether these coinfections are associated with adverse pregnancy outcomes and lower response to antiretroviral therapy (ART). METHODS: Pregnancies in HIV-1-infected women included in the ANRS French Perinatal Cohort between 2005 and 2013 were analyzed if HBV and HCV infection statuses were available. RESULTS: Among 4236 women, the prevalence of HBV (HBs Ag+) and HCV (RNA+) were 6...
December 27, 2017: Journal of Acquired Immune Deficiency Syndromes: JAIDS
Filiz F Bolukbas, Cengiz Bolukbas, Hatice Y Balaban, Cem Aygun, Seyda Ignak, Emine Ergul, Mehtap Yazicioglu, Suat S Ersahin
Aim: Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disease in pregnancy. Although it was shown that multiple pregnancy and hormone therapies increase the risk of ICP, there is limited information that compared spontaneous fertilization and in vitro fertilization (IVF) from the aspect of developing ICP. In our study, we investigated the potential relationship between ICP and IVF/ spontaneous pregnancy. Materials and methods: We reviewed the records (between June 2007 and December 2014) of pregnancies with ICP who were referred to gastroenterology clinics in three different hospitals...
July 2017: Euroasian Journal of Hepato-Gastroenterology
Maria Maldonado, Ali Alhousseini, Michael Awadalla, Jay Idler, Robert Welch, Karoline Puder, Manasi Patwardhan, Bernard Gonik
Intrahepatic cholestasis of pregnancy is seldom associated with significant vitamin K deficiency. We report a case of a 16-year-old primigravid patient at 24 weeks and 3 days of gestation who presented with pruritus, hematuria, and preterm labor. Laboratory work-up showed severe coagulopathy with Prothrombin Time (PT) of 117.8 seconds, International Normalized Ratio (INR) of 10.34, and elevated transaminases suggestive of intrahepatic cholestasis of pregnancy. Her serum vitamin K level was undetectable (<0...
2017: Case Reports in Obstetrics and Gynecology
Mirjami Mattila, Helena Kemppainen, Helena Isoniemi, Päivi Polo-Kantola
INTRODUCTION: Pregnancy after liver transplantation is possible but associated with increased risk of obstetrical complications. We report here for the first time the pregnancy outcomes after liver transplantation in Finland. MATERIAL AND METHODS: All of the 25 pregnancies ending in deliveries after liver transplantation in Finland in 1998-2015 were analyzed. The data were collected from the mothers' medical records. The main outcome measures included pregnancy complications and the mode of delivery...
September 2017: Acta Obstetricia et Gynecologica Scandinavica
Dan Shan, Yayi Hu, Peiyuan Qiu, Bechu Shelley Mathew, Yun Chen, Si Li, Yuan Hu, Lijun Lin, Zhi Wang, Luping Li
The aim of the present work was to determine maternal and fetal outcomes of intrahepatic cholestasis of pregnancy (ICP) in twin pregnancies. All twin pregnancies delivered above 28 gestational weeks in West China Second University Hospital from January 2013 to May 2015 were included. Data on maternal demographics and obstetric complications together with fetal outcomes were collected. The risk of adverse maternal and fetal outcomes were determined in relation to ICP by crude odds ratios (OR) and adjusted ORs (aOR) with 95% confidence intervals (CI)...
December 2016: Twin Research and Human Genetics: the Official Journal of the International Society for Twin Studies
Ibrahim Uyar, Ibrahim Gülhan, Deniz Öztekin, Cenk Gezer, Atalay Ekin, Seçil Karaca Kurtulmuş, Mehmet Özeren
BACKGROUND/AIM: To evaluate patients hospitalized in our clinic in the last 5 years with the diagnosis of intrahepatic cholestasis of pregnancy (ICP). MATERIALS AND METHODS: One hundred and fifty patients hospitalized with a diagnosis of ICP between January 2008 and May 2013 were evaluated retrospectively and age, week at diagnosis, gestational age at delivery, period between diagnosis and delivery, fetal weight, transaminases, and coagulation parameters were recorded...
2015: Turkish Journal of Medical Sciences
Sebiha Ozkan, Yasin Ceylan, Orhan Veli Ozkan, Sule Yildirim
Intrahepatic cholestasis of pregnancy (ICP) is a reversible pregnancy-specific cholestatic condition characterized by pruritus, elevated liver enzymes, and increased serum bile acids. It commences usually in the late second or third trimester, and quickly resolves after delivery. The incidence is higher in South American and Scandinavian countries (9.2%-15.6% and 1.5%, respectively) than in Europe (0.1%-0.2%). The etiology is multifactorial where genetic, endocrine, and environmental factors interact. Maternal outcome is usually benign, whereas fetal complications such as preterm labor, meconium staining, fetal distress, and sudden intrauterine fetal demise not infrequently lead to considerable perinatal morbidity and mortality...
June 21, 2015: World Journal of Gastroenterology: WJG
Yael Raz, Anat Lavie, Yaffa Vered, Ilana Goldiner, Avital Skornick-Rapaport, Ysca Landsberg Asher, Sharon Maslovitz, Ishai Levin, Joseph B Lessing, Michael J Kuperminc, Eli Rimon
OBJECTIVE: Intrahepatic cholestasis of pregnancy (ICP) is known to be associated with fetal complications. It recently was suggested to be associated possibly with preeclampsia (PET) as well. The objective of this study was to investigate that possibility. STUDY DESIGN: The study group included 78 women (54 singleton and 24 twin pregnancies) who had been diagnosed with ICP based on clinical presentation, elevated liver enzymes, and elevated total bile acids (>10 μmol/L)...
September 2015: American Journal of Obstetrics and Gynecology
Kenya Kamimura, Hiroyuki Abe, Hirokazu Kawai, Hiroteru Kamimura, Yuji Kobayashi, Minoru Nomoto, Yutaka Aoyagi, Shuji Terai
Liver disease in pregnancy is rare but pregnancy-related liver diseases may cause threat to fetal and maternal survival. It includes pre-eclampsia; eclampsia; haemolysis, elevated liver enzymes, and low platelets syndrome; acute fatty liver of pregnancy; hyperemesis gravidarum; and intrahepatic cholestasis of pregnancy. Recent basic researches have shown the various etiologies involved in this disease entity. With these advances, rapid diagnosis is essential for severe cases since the decision of immediate delivery is important for maternal and fetal survival...
May 7, 2015: World Journal of Gastroenterology: WJG
Catherine Brumby, Irena Idel, Rebecca Still, Lee Skeat, Lawrence P McMahon
OBJECTIVES: Disorders associated with marked liver dysfunction in late pregnancy include pre-eclampsia, HELLP syndrome, obstetric cholestasis, and acute fatty liver of pregnancy. Accurate diagnosis and appropriate timing of delivery are required in these conditions to minimize risk of maternal and fetal morbidity/mortality. We report a case series of women with significant and persistent liver dysfunction (>3-fold rise = ALT >90 IU/L) in the third trimester, where a definitive diagnosis remained obscure using accepted diagnostic tools for these and other liver conditions...
January 2015: Pregnancy Hypertension
Anela Puljic, Elissa Kim, Jessica Page, Tania Esakoff, Brian Shaffer, Daphne Y LaCoursiere, Aaron B Caughey
OBJECTIVE: The objective of the study was to characterize the risk of infant and fetal death by each additional week of expectant management vs immediate delivery in pregnancies complicated by cholestasis. STUDY DESIGN: This was a retrospective cohort study of 1,604,386 singleton, nonanomalous pregnancies of women between 34 and 40 weeks' gestation with and without intrahepatic cholestasis of pregnancy (ICP) in the state of California during the years of 2005-2008...
May 2015: American Journal of Obstetrics and Gynecology
Alexander DeLeon, Gildasio S De Oliveira, Manoj Kalayil, Shweta Narang, Robert J McCarthy, Cynthia A Wong
STUDY OBJECTIVE: To estimate the incidence of coagulopathy in patients with intrahepatic cholestasis inhepatic cholestasis of pregnancy (ICP). DESIGN: Retrospective cohort investigation. SETTING: University medical center. MEASUREMENTS: The records of 319 parturients who met study inclusion criteria were reviewed for various laboratory values. The primary outcome was the incidence of abnormal hemostasis, defined as prothrombin time (PT) greater than 14...
December 2014: Journal of Clinical Anesthesia
R Madazli, M A Yuksel, M Oncul, A Tuten, O Guralp, B Aydin
The aim of this study was to describe maternal and fetal characteristics associated with intrahepatic cholestasis of pregnancy (ICP) and to determine clinical and biochemical predictors of fetal complications. A total of 89 singleton pregnancies with ICP were analysed, retrospectively. All data concerning laboratory results, symptom onset time, treatment response, delivery time and infant information were recorded in the study protocol. The mean gestational age at diagnosis was 32.6 ± 3.4 weeks; mean time of delivery was 36...
May 2015: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
Jamie O Lo, Brian L Shaffer, Allison J Allen, Sarah E Little, Yvonne W Cheng, Aaron B Caughey
OBJECTIVE: We examined the morbidities from delivery at earlier gestational ages versus intrauterine fetal demise (IUFD) for women with intrahepatic cholestasis of pregnancy (ICP) to determine the optimal gestational age for delivery. METHODS: A decision-analytic model was created to compare delivery at 35 through 38 weeks gestation for different delivery strategies: (1) empiric steroids; (2) steroids if fetal lung maturity (FLM) negative; (3) wait a week and retest if FLM negative; or (4) deliver immediately...
2015: Journal of Maternal-fetal & Neonatal Medicine
A Licata, D Ingrassia, A Serruto, M Soresi, L Giannitrapani, G Montalto, A Craxì, P L Almasio
Pregnancy is a para-physiologic condition, which usually evolves without any complications in the majority of women, even if in some circumstances moderate or severe clinical problems can also occur. Among complications occurring during the second and the third trimester very important are those considered as concurrent to pregnancy such as hyperemesis gravidarum, intrahepatic cholestasis of pregnancy, HELLP syndrome and acute fatty liver of pregnancy. The liver diseases concurrent to pregnancy typically occur at specific times during the gestation and they may lead to significant maternal and foetal morbidity and mortality...
June 2015: Journal of Viral Hepatitis
Jyotsna Rani, Dharamshila Sharma, Alka Sehgal
BACKGROUND: Cervical dilatation documented on partogram indicates expected rate of progress of labour and deviations from alert line indicates abnormal progress of labour. Its early detection and timely intervention can reduce fetomaternal morbidity. PURPOSE: To study the role of partogram in the management of labouring mothers with high risk pregnancies at a tertiary care centre. METHOD: Four hundred primigravidas with high risk pregnancies in active labour (with cervical dilatation ≥ 4 cm) were studied, divided into two groups as Partogram and no Partogram group and each group consisted of 200 patients...
January 2015: Archives of Gynecology and Obstetrics
Victoria Geenes, Anita Lövgren-Sandblom, Lisbet Benthin, Dominic Lawrance, Jenny Chambers, Vinita Gurung, Jim Thornton, Lucy Chappell, Erum Khan, Peter Dixon, Hanns-Ulrich Marschall, Catherine Williamson
Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disorder associated with an increased risk of adverse fetal outcomes. It is characterised by raised maternal serum bile acids, which are believed to cause the adverse outcomes. ICP is commonly treated with ursodeoxycholic acid (UDCA). This study aimed to determine the fetal and maternal bile acid profiles in normal and ICP pregnancies, and to examine the effect of UDCA treatment. Matched maternal and umbilical cord serum samples were collected from untreated ICP (n = 18), UDCA-treated ICP (n = 46) and uncomplicated pregnancy (n = 15) cases at the time of delivery...
2014: PloS One
Anna Kowalska-Kańka, Tomasz Maciejewski, Krzysztof Tomasz Niemiec
UNLABELLED: Intrahepatic cholestasis of pregnancy (ICP) is not a common complication of pregnancy, but may be a threat to fetal condition. The elevated level of bile acids defines ICP and determines its severity. Indicators of hepatocyte damage during ICP are elevated ALT and AST. The fetal condition in the ICP depends on the degree of liver damage. The most common complication is preterm delivery, but the risk of fetal death is currently around 3.5%. Erythropoietin is a peptide hormone produced mostly in the kidneys and liver due to tissue hypoxia...
July 2013: Medycyna Wieku Rozwojowego
Khulood T Ahmed, Ashraf A Almashhrawi, Rubayat N Rahman, Ghassan M Hammoud, Jamal A Ibdah
Pregnancy is a special clinical state with several normal physiological changes that influence body organs including the liver. Liver disease can cause significant morbidity and mortality in both pregnant women and their infants. This review summarizes liver diseases that are unique to pregnancy. We discuss clinical conditions that are seen only in pregnant women and involve the liver; from Hyperemesis Gravidarum that happens in 1 out of 200 pregnancies and Intrahepatic Cholestasis of Pregnancy (0.5%-1.5% prevalence), to the more frequent condition of preeclampsia (10% prevalence) and its severe form; hemolysis, elevated liver enzymes, and a low platelet count syndrome (12% of pregnancies with preeclampsia), to the rare entity of Acute Fatty Liver of Pregnancy (incidence of 1 per 7270 to 13000 deliveries)...
November 21, 2013: World Journal of Gastroenterology: WJG
Lei Li, Xin-Yan Zhao, Xiao-Juan Ou, Ji-Dong Jia
OBJECTIVE: To generate a comprehensive clinical profile of intrahepatic cholestasis of pregnancy (ICP) by systematically reviewing ICP cases managed in our hospital. METHODS: The recorded clinical data, including diagnosis, complications, management, and maternal and infant outcomes, of nine ICP cases were collected retrospectively and reviewed systematically. RESULTS: Seven of the nine total ICP patients presented with pruritus. All nine of the ICP patients showed bile acid level beyond the normal range...
April 2013: Zhonghua Gan Zang Bing za Zhi, Zhonghua Ganzangbing Zazhi, Chinese Journal of Hepatology
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