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Schwangerschaftscholestase


Haslinger, C; Gonser, M (2015). Schwangerschaftscholestase. Der Gynäkologe, 48(11):817-827.

Abstract

Die Schwangerschaftscholestase (“intrahepatic cholestasis of pregnancy“, ICP) ist die häufigste schwangerschaftsbedingte Lebererkrankung. Sie tritt in der zweiten Schwangerschaftshälfte auf und ist gekennzeichnet durch teils massiv störenden, nachts vermehrten Pruritus und den laborchemischen Nachweis erhöhter Gallensäuren im mütterlichen Serum. Die ICP hat eine gute mütterliche Prognose, ist jedoch mit schlechtem fetalen Outcome assoziiert, wie Frühgeburt, Mekoniumabgang, pathologischem Kardiotokogramm (CTG) oder intrauterinem Fruchttod (IUFT). Die Therapie der Wahl ist Ursodeoxycholsäure (UDCA, Ursodiol), die nachweislich den Pruritus verringert und die Gallensäuren senkt. Ein IUFT ist bei der ICP Folge einer akuten Asphyxie und nicht einer chronischen uteroplazentaren Insuffizienz, weshalb übliche antenatale Überwachungsmethoden nicht vorwarnen. Von vielen Autoren wird daher die Geburtseinleitung, je nach Höhe der Gallensäuren, ab 37 Schwangerschaftswochen empfohlen.

Intrahepatic cholestasis of pregnancy (ICP) is the most common pregnancy-related liver disease. It occurs in the second half of pregnancy and is characterized by sometimes intensive, nocturnally increased maternal pruritus and raised maternal serum bile acid levels. The ICP has a good prognosis for the mother with usually rapid recovery after delivery but is associated with adverse fetal outcomes, such as preterm delivery, intrapartum fetal distress, meconium contamination of the amniotic fluid and stillbirth, particularly near term. Ursodeoxycholic acid (UDCA) is considered to be the first-line treatment for ICP and was shown to reduce maternal pruritus and to lower maternal serum bile acid levels. Stillbirth due to ICP is a consequence of acute anoxia and not due to chronic uteroplacental insufficiency. As a consequence the usual methods of fetal monitoring, such as ultrasound or cardiotocography (CTG), cannot be used to predict an adverse perinatal outcome. For this reason, early induction of labor after 37 weeks of gestation, also depending on serum bile acid levels, is recommended by many authors.

Abstract

Die Schwangerschaftscholestase (“intrahepatic cholestasis of pregnancy“, ICP) ist die häufigste schwangerschaftsbedingte Lebererkrankung. Sie tritt in der zweiten Schwangerschaftshälfte auf und ist gekennzeichnet durch teils massiv störenden, nachts vermehrten Pruritus und den laborchemischen Nachweis erhöhter Gallensäuren im mütterlichen Serum. Die ICP hat eine gute mütterliche Prognose, ist jedoch mit schlechtem fetalen Outcome assoziiert, wie Frühgeburt, Mekoniumabgang, pathologischem Kardiotokogramm (CTG) oder intrauterinem Fruchttod (IUFT). Die Therapie der Wahl ist Ursodeoxycholsäure (UDCA, Ursodiol), die nachweislich den Pruritus verringert und die Gallensäuren senkt. Ein IUFT ist bei der ICP Folge einer akuten Asphyxie und nicht einer chronischen uteroplazentaren Insuffizienz, weshalb übliche antenatale Überwachungsmethoden nicht vorwarnen. Von vielen Autoren wird daher die Geburtseinleitung, je nach Höhe der Gallensäuren, ab 37 Schwangerschaftswochen empfohlen.

Intrahepatic cholestasis of pregnancy (ICP) is the most common pregnancy-related liver disease. It occurs in the second half of pregnancy and is characterized by sometimes intensive, nocturnally increased maternal pruritus and raised maternal serum bile acid levels. The ICP has a good prognosis for the mother with usually rapid recovery after delivery but is associated with adverse fetal outcomes, such as preterm delivery, intrapartum fetal distress, meconium contamination of the amniotic fluid and stillbirth, particularly near term. Ursodeoxycholic acid (UDCA) is considered to be the first-line treatment for ICP and was shown to reduce maternal pruritus and to lower maternal serum bile acid levels. Stillbirth due to ICP is a consequence of acute anoxia and not due to chronic uteroplacental insufficiency. As a consequence the usual methods of fetal monitoring, such as ultrasound or cardiotocography (CTG), cannot be used to predict an adverse perinatal outcome. For this reason, early induction of labor after 37 weeks of gestation, also depending on serum bile acid levels, is recommended by many authors.

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Additional indexing

Item Type:Journal Article, not refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Obstetrics
Dewey Decimal Classification:610 Medicine & health
Language:German
Date:2015
Deposited On:28 Dec 2015 07:26
Last Modified:05 Apr 2016 19:47
Publisher:Springer
ISSN:0017-5994
Publisher DOI:https://doi.org/10.1007/s00129-015-3797-6

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