INTRAHEPATIC CHOLESTASIS OF PREGNANCY - M ATERNAL AND FETAL IMPLICATIONS

Objetive: To analyze a group of pregnancies complicated by intrahepati c cholestasis in order to favour an early recognition and to decrease maternal and fetal morbi-mortality. Patients and methods: Retrospectiv e study of 46 pregnancies with intrahepatic gravidic: cholestasis betw een 1990-94, We review the most relevant epidemiologic, clinical and b iological features and the obstetric and perinatal results, The study group was compared with 1652 non complicated pregnancies (control grou p) from the same period of time, The statistic evaluation was made wit h t Student and chi(2), Results: The incidence was 0.18% (mean age of 27.8 +/- 6.7 years) similar to the control group, and a greater rate o f primiparity (p < 0.05) and twin pregnancies (p < 0.001), The most fr ecuent syntom was pruritus, followed by choluria (23.9%) and signs of cutaneous scratching (17.3%), Only 5 patients (10.8%) had jaundice, Th e GPT was greater than 100 U/l in 29 cases (63.1%) and the GOT in 17 ( 37%), In 25 pregnancies (54.3%) the alkaline phos-phatase exceeded 600 U/L and 28 (60.8%) had bilirubin normal values, Urinary tract infecti ons (26%) and preterm labor (17.3%) were significantly more frequent ( p < 0.001) in patients with intrahepatic cholestasis of pregnancy, as well as induced labor rate and cesarean section percentages (p <: 0.00 1), The neonatal prognosis was significantly worse, with 10 preterm ba bies, 6 with 5 minutes Apgar score lower than 7, and 3 perinatal death s, All the patients recovered their normal status after delivery, Conc lusions: In intrahepatic gravidic cholestasis moderate cytolysis, infr equent: jaundice and cholestasis can be important, The pregnancies sho uld be considered of high risk, and should be managed aggressively as soon as fetal maturity allows it.