OBGIN-L Mensajes a Junio, 2006: Re: Colestasis

A las que he tenido en mi pràctica privada (escasas las serias por suerte) las controlè con laboratorio (enzimas) y con perfil biof fetal diario (y a veces 2 por dìa) y por supuesto con la evoluciòn clinica obstetrica de todo el embarazo que para mì es sumamente ùtil (los datos de la madre en cuanto a movimientos me parece que sn muy ùtiles). Los interrumpì alrededor de las 38 semanas con excepciòn de uno que fue a las 36. No tengo màs que esto para manejarme y estar sola afuera trabajando es a veces difìcil, pero como siempre hay ayuda en las consultas uno no se siente tan solo. Lo que a veces me asusta es que soy yo la que hago todo (sin derivaciòn a estudios complementarios) y corro màs riesgo de equivocarme...pero bueno...es lo que tengo...saludos

Dra. Lewis

From:  "Dra. Alicia M. Lapidus" <alapi@fibertel.com.ar>
Reply-To:  obgin-l@obgyn.net
To:  Multiple recipients of list OBGIN-L <obgin-l@dns.obgyn.net>
Subject:  RE: Colestasis
Date:  Wed, 31 May 2006 20:00:07 -0500
>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_uids=16677568&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.
>