Abstract
Amaç: Gebeliğin intrahepatik kolestazında (ICP) fetal kalp debisini değerlendirmeyi amaçlıyoruz.
Gereçler ve yöntem: Çalışmaya 32 ICP izlenen hasta ve 42 sağlıklı gebe dahil edildi. Semptomatik gebelerde açlık safra asidi değeri >10 µmol/L saptanması ile ICP tanısı konuldu. Fetal ekokardiyografik değerlendirmeler >34 gebelik haftasında yapıldı. Gruplar arasında hastaların demografik verileri, fetal kalp debisi ve perinatal sonuçları karşılaştırıldı.
Bulgular: ICP grubunda aspartat aminotransferaz (AST) ve alanin aminotransferaz (ALT) kontrol grubuna göre daha yüksekti (p<0,001 ve p<0,001). Sol kalp debisi (LCO), sağ kalp debisi (RCO) ve kombine kalp debisi (CCO) gruplar arasında benzerdi (sırasıyla p=0.430, p=0.054, ve p=0.134). ICP izlenen hastalarda serum safra asidi (SBA) >40 µmol/L olanlar, şiddetli hastalık ve diğerleri hafif hastalık olarak iki gruba ayrıldı. ICP grubunun ağır hastalığında sağ, sol ve kombine kalp debisi azalmış olsa da istatistiksel olarak anlamlı bir fark yoktu (sırasıyla p=0,666, p=0,188 ve p=0,236).
Sonuç: Çalışmamızda ICP’nin fetal kalp debisi üzerinde herhangi bir olumsuz etkisi gözlemlemedik, ancak şiddetli ICP ile daha fazla çalışma yapılmalıdır.
References
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- 3. Piechota J, Jelski W. Intrahepatic Cholestasis in Pregnancy: Review of the Literature. Journal of Clinical Medicine 2020;9. https://doi.org/10.3390/JCM9051361.
- 4. Kenny JF, Plappert T, Doubilet P, Saltzman DH, Cartier M, Zollars L, et al. Changes in intracardiac blood flow velocities and right and left ventricular stroke volumes with gestational age in the normal human fetus: a prospective Doppler echocardiographic study. Circulation 1986;74:1208–16. https://doi.org/10.1161/01.CIR.74.6.1208.
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- 9. Kurtulmuş S, Gür EB, Öztekin D, Güleç EŞ, Okyay D, Gülhan İ. The impact of intrahepatic cholestasis of pregnancy on fetal cardiac and peripheral circulation. Journal of the Turkish German Gynecological Association 2015;16:74–9. https://doi.org/10.5152/JTGGA.2015.15173.
- 10. Fan X, Zhou Q, Zeng S, Zhou J, Peng Q, Zhang M, et al. Impaired fetal myocardial deformation in intrahepatic cholestasis of pregnancy. Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine 2014;33:1171–7. https://doi.org/10.7863/ULTRA.33.7.1171.
- 11. Stewart WJ, Jiang L, Mich R, Pandian N, Guerrero JL, Weyman AE. Variable effects of changes in flow rate through the aortic, pulmonary and mitral valves on valve area and flow velocity: impact on quantitative Doppler flow calculations. Journal of the American College of Cardiology 1985;6:653–62. https://doi.org/10.1016/S0735-1097(85)80127-3.
- 12. Fisher DC, Sahn DJ, Friedman MJ, Larson D, Valdes-Cruz LM, Horowitz S, et al. The mitral valve orifice method for noninvasive two-dimensional echo Doppler determinations of cardiac output. Circulation 1983;67:872–7. https://doi.org/10.1161/01.CIR.67.4.872.
- 13. Mielke G, Benda N. Cardiac output and central distribution of blood flow in the human fetus. Circulation 2001;103:1662–8. https://doi.org/10.1161/01.CIR.103.12.1662.
- 14. Narasimhan SL, Eid A, Bhatia A, Davey C, Steinberger J. Maternal diabetes and fetal cardiac output. Journal of Neonatal-Perinatal Medicine 2022;15:69–74. https://doi.org/10.3233/NPM-200552.
- 15. Kiserud T, Ebbing C, Kessler J, Rasmussen S. Fetal cardiac output, distribution to the placenta and impact of placental compromise. Ultrasound in Obstetrics & Gynecology : The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology 2006;28:126–36. https://doi.org/10.1002/UOG.2832.
Abstract
Aim: We aim to evaluate fetal cardiac output in intrahepatic cholestasis of pregnancy (ICP).
Material and Method: Thirty-two patients with ICP and 42 healthy pregnant women were included in the study. The diagnosis of ICP was made by detecting fasting bile acid value >10 µmol/L in symptomatic pregnant women. Fetal echocardiographic evaluations were performed >34 weeks of gestation. Demographic data, fetal cardiac output, and perinatal outcomes of the patients were compared between the groups.
Results: In the ICP group aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were higher than the control group (p<0.001 and p<0.001). The left cardiac output (LCO), right cardiac output (RCO) and combine cardiac output (CCO) were similar between the groups (p=0.430, p=0.054, and p=0.134 respectively). Patients with ICP were divided into two groups as patients with serum bile acid (SBA) >40 µmol/L, severe disease, and others mild disease. Although right, left, and combined cardiac output was decreased in the severe disease of the ICP group, there was no statistically significant difference (p=0.666, p=0.188, and p=0.236 respectively).
Conclusion: In our study, we did not observe any adverse effect of ICP on fetal cardiac output, but more studies with severe ICP should be conducted.
References
- 1. Paus TC, Schneider G, van de Vondel P, Sauerbruch T, Reichel C. Diagnosis and therapy of intrahepatic cholestasis of pregnancy. Zeitschrift Fur Gastroenterologie 2004;42:623–8. https://doi.org/10.1055/S-2004-813165.
- 2. Smith DD, Rood KM. Intrahepatic Cholestasis of Pregnancy. Clinical Obstetrics and Gynecology 2020;63:134–51. https://doi.org/10.1097/GRF.0000000000000495.
- 3. Piechota J, Jelski W. Intrahepatic Cholestasis in Pregnancy: Review of the Literature. Journal of Clinical Medicine 2020;9. https://doi.org/10.3390/JCM9051361.
- 4. Kenny JF, Plappert T, Doubilet P, Saltzman DH, Cartier M, Zollars L, et al. Changes in intracardiac blood flow velocities and right and left ventricular stroke volumes with gestational age in the normal human fetus: a prospective Doppler echocardiographic study. Circulation 1986;74:1208–16. https://doi.org/10.1161/01.CIR.74.6.1208.
- 5. Arduini D, Rizzo G, Mancuso S, Romanini C. Longitudinal assessment of blood flow velocity waveforms in the healthy human fetus. Prenatal Diagnosis 1987;7:613–7. https://doi.org/10.1002/PD.1970070902.
- 6. Bouscarel B, Kroll SD, Fromm H. Signal transduction and hepatocellular bile acid transport: cross talk between bile acids and second messengers. Gastroenterology 1999;117:433–52. https://doi.org/10.1053/GAST.1999.0029900433.
- 7. Williamson C, Miragoli M, Sheikh Abdul Kadir S, Abu-Hayyeh S, Papacleovoulou G, Geenes V, et al. Bile acid signaling in fetal tissues: implications for intrahepatic cholestasis of pregnancy. Digestive Diseases (Basel, Switzerland) 2011;29:58–61. https://doi.org/10.1159/000324130.
- 8. Gorelik J, Harding SE, Shevchuk AI, Koralage D, Lab M, de Swiet M, et al. Taurocholate induces changes in rat cardiomyocyte contraction and calcium dynamics. Clinical Science 2002;103:191–200. https://doi.org/10.1042/cs1030191.
- 9. Kurtulmuş S, Gür EB, Öztekin D, Güleç EŞ, Okyay D, Gülhan İ. The impact of intrahepatic cholestasis of pregnancy on fetal cardiac and peripheral circulation. Journal of the Turkish German Gynecological Association 2015;16:74–9. https://doi.org/10.5152/JTGGA.2015.15173.
- 10. Fan X, Zhou Q, Zeng S, Zhou J, Peng Q, Zhang M, et al. Impaired fetal myocardial deformation in intrahepatic cholestasis of pregnancy. Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine 2014;33:1171–7. https://doi.org/10.7863/ULTRA.33.7.1171.
- 11. Stewart WJ, Jiang L, Mich R, Pandian N, Guerrero JL, Weyman AE. Variable effects of changes in flow rate through the aortic, pulmonary and mitral valves on valve area and flow velocity: impact on quantitative Doppler flow calculations. Journal of the American College of Cardiology 1985;6:653–62. https://doi.org/10.1016/S0735-1097(85)80127-3.
- 12. Fisher DC, Sahn DJ, Friedman MJ, Larson D, Valdes-Cruz LM, Horowitz S, et al. The mitral valve orifice method for noninvasive two-dimensional echo Doppler determinations of cardiac output. Circulation 1983;67:872–7. https://doi.org/10.1161/01.CIR.67.4.872.
- 13. Mielke G, Benda N. Cardiac output and central distribution of blood flow in the human fetus. Circulation 2001;103:1662–8. https://doi.org/10.1161/01.CIR.103.12.1662.
- 14. Narasimhan SL, Eid A, Bhatia A, Davey C, Steinberger J. Maternal diabetes and fetal cardiac output. Journal of Neonatal-Perinatal Medicine 2022;15:69–74. https://doi.org/10.3233/NPM-200552.
- 15. Kiserud T, Ebbing C, Kessler J, Rasmussen S. Fetal cardiac output, distribution to the placenta and impact of placental compromise. Ultrasound in Obstetrics & Gynecology : The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology 2006;28:126–36. https://doi.org/10.1002/UOG.2832.
Details
| Primary Language | English |
|---|---|
| Subjects | Obstetrics and Gynaecology |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | March 25, 2022 |
| Submission Date | February 7, 2022 |
| Acceptance Date | March 10, 2022 |
| Published in Issue | Year 2022 Volume: 19 Issue: 1 |
