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Re: Colestasis
From: Dra. Alicia M. Lapidus (alapi@fibertel.com.ar)
Wed May 31 19:58:43 2006
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Miren las estadísticas de este trabajo de China. A nosotros no nos va tan mal...Perinatal outcomes of intrahepatic cholestasis of pregnancy: analysis of 1210 cases]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Ab stract&list_uids677568&itool=iconabstr&query_hl=1&itool=pubmed_docsum
Wang XD, Peng B, Yao Q, Zhang L, Ai Y, Xing AY, Liu XH, Liu SY.
Department of Obstetrics and Gynecology, West China Second Hospital of Sichuan University, Chengdu 610041, China.
OBJECTIVE: To study the perinatal outcomes of intrahepatic cholestasis of pregnancy (ICP). METHODS: The clinical data of 1210 cases of ICP in recent ten years were retrospectively analyzed. RESULTS: The incidence rates of perinatal outcomes of ICP were as follows: 19.0% (230/1210) for threatened premature labor, 24.0% (290/1210) for premature delivery; 23.2% (281/1210) for meconium stained amniotic fluid, 7.1% (86/1210) for neonatal asphyxia, 22.5 per thousand (27/1210) for perinatal mortality, 85.9% (1039/1210) for cesarean section, 0.9% (11/1210) for fetal growth restriction (FGR), 1.4% (17/1210) for postpartum hemorrhage, and 8.1% (101/1210) for preeclampsia. Threatened premature labor occurred beyond the gestation gestation period of 32 weeks in 88.7% (204/230) of the patients, and the fetal death rate in threatened premature labor was 46.7% (7/15). Premature delivery occurred after 34 weeks of gestation in 96.2% of the patients (279/290) 89.7% (260/290) of which were caused by cesarean section because of abnormal fetal monitoring. 41.3% of the cases with meconium stained amniotic fluid (116/281) occurred before the onset of labor. Fetal death accounted for 56% (15/27) of perinatal death, 80% (12/15) of which happened after the gestation week of 35 (36.5 +/- 1.2) with normal fetal heart rate monitoring. 95% (19/20) of the fetal death and stillbirth occurred after threatened premature labor and occasional uterine contractions, or at the early stage of labor. CONCLUSION: The rates of FGR, postpartum hemorrhage, and preeclampsia in ICP are almost the same as those of the normal pregnancy. Routine fetal heart rate monitoring methods cannot predict fetal death. The important measures to decrease the perinatal mortality include paying attention to fetal monitoring when threatened premature labor, occasional uterine contractions and prenatal meconium occur, and at the early stage of labor, and management of threatened premature labor and timely intervention of pregnancy (at the gestation period of 34 - 37 weeks).
-- Dra. Alicia M. Lapidus Buenos Aires Argentina-----Original Message----- From: obgin-l@obgyn.net [mailto:obgin-l@obgyn.net] On Behalf Of Jtarruella@aol.com Sent: Wednesday, 31 May, 2006 20:06 To: Multiple recipients of list OBGIN-L Subject: Re: Colestasis
Estimada Alicia, no se que frecuencia tienen en tu servicio, pero en el mio (Htal.San Fernando,BsAs)no pasa semana que no tengamos alguna paciente internada con colestasis,medicamos con ac.ursodesoxicolico comenzanso con 300 mg/dia, reposo y dieta hepatoprotectora, en gral con buena respuesta,pero interrumpimos el embarazo si pese al tratamiento las enzimas no bajan o aumentan en las 72 hs luego de iniciado el mismo.Me gustaria conocer tus experiencias y la de los colegas del foro.Saludos.Dr.Juan Tarruella.
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