Predicting fetal asphyxia in intrahepatic cholestasis of pregnancy.
OBJECTIVE
Intrahepatic cholestasis of pregnancy (ICP) is a disease associated with high-perinatal morbidity and mortality rates. It is important to have parameters that aid in predicting fetal outcomes. Certain parameters affecting asphyxia in newborns to mothers with ICP are evaluated in this study.


METHODS
One hundred eighty-seven cholestatic pregnancies were analyzed, retrospectively. Fetal asphyxia was defined as an APGAR score of less than 7 at 5 min postpartum. Predictors of asphyxia in ICP were analyzed by binary multivariate logistic regression analysis.


RESULTS
Thirty-six of the cholestatic pregnancies ended up having an asphyctic newborn at the time of delivery (19.2%). There was a statistically significance difference in the levels of total bile acids (TBA) (42.4 +/- 15.2 vs. 33.8 +/- 12.9 micromol/L, P < 0.01), HDL cholesterol (54.2 +/- 15.9 vs. 61.3 +/- 12.2, P = 0.01), total cholesterol (279.0 +/- 51.4 vs. 257.7 +/- 51.6, P = 0.02), and triacylglycerol (299.4 +/- 94.6 vs. 260.4 +/- 118.7) between the asphytic and nonasphytic group. Binary multivariate logistic regression analysis demonstrated that TBA levels (OR 1.04, 95% CI 1.01-1.08, P = 0.03) and exposure time (OR 1.11, 95% CI 1.05-1.17, P < 0.01) were the most important independent variables predicting fetal asphyxia in ICP.


CONCLUSIONS
In this study, it has been demonstrated that for the evaluation of fetal status, increased TBA levels in the mother and increased exposure time for the fetus to these increased values of TBA within the maternal circulation system help to predict increased risk of asphyxia in newborns to ICP mothers.
Oztekin
Deniz
D
Department of Obstetrics and Gynecology, Agean Obstetrics and Gynecology Training and Research Hospital, Izmir, Turkey. dcoztekin@gmail.com
Aydal
Ipek
I
Oztekin
Ozgur
O
Okcu
Sabriye
S
Borekci
Rengin
R
Tinar
Sivekar
S