Gebelik intrahepatik kolestazının şiddeti, prostaglandin E2 ile indüklenen multipar kadınlarda doğumun ilk aşamasını kısaltabilir

Year 2020, Volume: 12 Issue: 2, 251 - 257, 01.06.2020

Banuhan Şahin , Samettin Çelik , Canan Soyer , Şafak Hatırnaz , Handan Çelik

https://doi.org/10.21601/ortadogutipdergisi.737898

Abstract

Amaç: Vajinal prostaglandin E2 (PGE2) ile indüklenen multipar kadınlarda gebeliğin intrahepatik kolestazına (ICP) bağlı artan serum safra asit konsantrasyonları ile doğumun ilk evresi arasındaki ilişkiyi belirlemek.
Gereç ve Yöntemler: Bu retrospektif vaka-kontrol çalışmasında 283 ICP’li ve 283 sağlıklı multipar gebe doğum indüksiyonu için kabul edildi, vajinal olarak PGE2 (10 mg dinoproston) yerleştirildi. Hafif, orta ve şiddetli ICP’li gruplar, PGE2’nin vajinal yerleştirilmesinin başlangıcından doğumun aktif evresine kadar geçen süreler, PGE2’nin vajinal yerleştirilmesinin başlangıcından serviksin tamamen dilatasyonuna kadar geçen süreler ve fetal sonuçlar açısından kontrol grubu ile karşılaştırıldı.
Bulgular: Hafif, orta ve şiddetli ICP gruplarında PGE2’nin yerleştirilmesinin başlangıcından aktif evreye kadar geçen süre ICP olmayan gruptakine göre daha kısaydı; sırasıyla, 3,19±0,32, 7,26±0,34, 8,71±0,35 saat (p <0,01). Hafif, orta ve şiddetli ICP gruplarında PGE2’nin yerleştirilmesinin başlangıcından serviksin tamamen dilatasyonuna kadar geçen süre ICP olmayan gruptakine göre daha kısaydı; sırasıyla, 3,03±0,45, 10,33±0,62, 14,44±0,53 saat (p <0,01). Gruplar arasında fetal ağırlık ve mekonyum varlığı dışında fetal sonuçlar açısından fark yoktu (p <0,01).
Sonuç: Hafif, orta ve şiddetli ICP’de vajinal PGE2 ile indüklenen multipar gebe kadınlarda artan safra asidi konsantrasyonları, daha kısa servikal olgunlaşma süresi ve daha kısa doğum indüksiyon süresi ile ilişkilidir. Bu çalışma, ICP’li multipar gebelerin kolestazın şiddeti arttıkça daha hızlı doğum yapabilecekleri sonucuna vardı.

Keywords

doğum süresi, gebeliğin intrahepatik kolestazı, kolestazın şiddeti, prostaglandin E2, safra asidi

The severity of intrahepatic cholestasis of pregnancy can shorten the first stage of labor in multiparous women induced by prostaglandin E2

Abstract

Aim: To determine the relationship between increased serum bile acid concentrations and the first stage of labor in multiparous women induced by vaginal prostaglandin E2 (PGE2) with intrahepatic cholestasis of pregnancy (ICP).
Material and Methods: In this retrospective case-control study 283 multiparous women with ICP and 283 healthy multiparous pregnant women were admitted for induction of delivery, were inserted PGE2 (10 mg dinoprostone) vaginally. The groups with mild, moderate and severe ICP were compared with control group in terms of the time from beginning of PGE2 vaginal insertion to active phase of labor, the time from beginning of PGE2 vaginal insertion to complete dilatation of cervix and fetal outcomes.
Results: The time from beginning of PGE2 insertion to active phase in the mild, moderate and severe ICP groups were shorter than in the non-ICP group; 3.19±0.32, 7.26±0.34, 8.71±0.35 hours, respectively (p<0.01). The time from beginning of PGE2 insertion to complete dilatation of cervix in the groups with mild, moderate and severe ICP were shorter than in non-ICP group; 3.03 ± 0.45; 10.33 ± 0.62; 14.44 ± 0.53, respectively (p<0.01). There was no difference between the groups in terms of fetal outcomes except fetal weight and the presence of meconium (p<0.01).
Conclusion: Increased bile acid concentrations in multiparous pregnant women induced by vaginal PGE2 with mild, moderate and severe ICP are associated with shorter duration of cervical ripening and labor induction time to delivery. The study concluded that multiparous women with ICP can deliver faster as the severity of cholestasis increases.

Keywords

bile acid, duration of labor, intrahepatic cholestasis of pregnancy, prostaglandin E2, severity of cholestasis

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