Principles of treatment of intrahepatic cholestasis of pregnant women
- Authors: Zhestkova N.V.1,2, Aylamazyan E.K.1,2,3, Kuzminykh T.U.1, Marchenko N.V.1,4
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Affiliations:
- St. Petersburg State University
- The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott
- Academician I.P. Pavlov First St. Petersburg State Medical University
- Academician A.M. Granov Russian Research Center for Radiology and Surgical Technologies
- Issue: Vol 72, No 2 (2023)
- Pages: 31-38
- Section: Original Research
- URL: https://journals.rcsi.science/jowd/article/view/131192
- DOI: https://doi.org/10.17816/JOWD321213
- ID: 131192
Cite item
Abstract
BACKGROUND: Intrahepatic cholestasis of pregnancy occupies a leading place in the structure of hepatoses associated with pregnancy. As with many other diseases that debut during gestation, all the symptoms of intrahepatic cholestasis of pregnancy disappear after delivery and have no consequences for the mother, unlike, for example, acute fatty degeneration of the liver. However, the fetal prognosis remains serious due to the high incidence of preterm birth and the toxic effect of bile components on the developing fetus, which both lead to perinatal complications. Especially fatal is the situation when intrahepatic cholestasis of pregnancy is combined with intrauterine infection, placental insufficiency, severe preeclampsia, diabetes mellitus, or other extragenital pathology. Until recently, it was believed that the only correct solution for intrahepatic cholestasis of pregnancy development was early delivery. Only in recent decades, attempts have been made to therapeutic correction of this pathology in order to prolong pregnancy to full term and reduce the frequency of perinatal complications. So far, tangible results have been achieved with the use of ursodeoxycholic acid preparations and the introduction of efferent methods of therapy into obstetric practice.
AIM: The aim of this study was to develop optimal schemes for pathogenetic therapy of intrahepatic cholestasis of pregnancy using hepatoprotectors from the ursodeoxycholic acid group, as well as ademetionine, essential phospholipids, and membrane plasmapheresis.
MATERIALS AND METHODS: This study included 150 pregnant women with intrahepatic cholestasis of pregnancy. Group I (n = 50) comprised patients who were treated only with ursodeoxycholic acid. Group II (n = 50) included individuals who were given combined drug therapy with ursodeoxycholic acid, ademetionine, and essential phospholipids. Group III (n = 50) consisted of women whose treatment included efferent therapies (membrane plasmapheresis) in combination with ursodeoxycholic acid or ademetionine preparations. All pregnant women before the start of therapy were determined the blood levels of bile acids, total and direct bilirubin, and transaminases (alanine aminotransferase, aspartate aminotransferase). Blood parameters were monitored once every seven days. All the patients were also monitored for the condition of the fetus (fetometry, dopplerometry, cardiotocography).
RESULTS: The use of ursodeoxycholic acid not combined with other hepatoprotectors (group I) was possible only in cases of increased blood levels of bile acids of not more than 40 mmol/L, preparations of ademetionine and essential phospholipids as monotherapy being ineffective. With an increase in the blood levels of bile acids of more than 40 mmol/L and transaminases by two to three or more times from the upper limit of the norm (group II), the most effective was the combined use of ursodeoxycholic acid, ademetionine and essential phospholipid preparations. The most significant decrease in the blood levels of bile acids and hepatic cytolysis parameters (transaminases) was observed when plasmapheresis was used in combination with ursodeoxycholic acid or ademetionine (group III).
CONCLUSIONS: The choice of treatment regimen depends on the level of increase in bile acids and the severity of cytolytic syndrome. With an increase in the level of bile acids to 40 mmol/L, ursodeoxycholic acid preparations can be used only. With an increase in bile acid level of more than 40 mmol/L, the complex use of the above hepatoprotectors is necessary. The most effective treatment regimen is the use of membrane plasmapheresis in combination with ursodeoxycholic acid or ademetionine.
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##article.viewOnOriginalSite##About the authors
Natalia V. Zhestkova
St. Petersburg State University; The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott
Author for correspondence.
Email: zhestkova@me.com
ORCID iD: 0000-0001-8078-3524
SPIN-code: 6014-8153
Scopus Author ID: 57175940900
ResearcherId: N-5303-2015
MD, Cand. Sci. (Med.)
Russian Federation, Saint Petersburg; Saint PetersburgEduard K. Aylamazyan
St. Petersburg State University; The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott; Academician I.P. Pavlov First St. Petersburg State Medical University
Email: ailamazyan@icloud.com
ORCID iD: 0000-0002-9848-0860
SPIN-code: 9911-1160
Scopus Author ID: 6506821393
ResearcherId: G-2219-2014
MD, Dr. Sci. (Med.), Professor, Honored Scientist of the Russian Federation, Academician of the Russian Academy of Sciences
Russian Federation, Saint Petersburg; Saint Petersburg; Saint PetersburgTatyana U. Kuzminykh
St. Petersburg State University
Email: 9260@mail.ru
ORCID iD: 0000-0002-6136-5324
SPIN-code: 7747-6724
Scopus Author ID: 56719818800
ResearcherId: U-8950-2017
MD, Dr. Sci. (Med.), Assistant Professor
Russian Federation, Saint PetersburgNatalia V. Marchenko
St. Petersburg State University; Academician A.M. Granov Russian Research Center for Radiology and Surgical Technologies
Email: dr.marchenko@gmail.com
ORCID iD: 0000-0002-6738-6417
SPIN-code: 7262-1746
Scopus Author ID: 55342430200
ResearcherId: O-8777-2014
MD, Cand. Sci. (Med.)
Russian Federation, Saint Petersburg; Saint PetersburgReferences
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