title: High mean platelet volume, low-grade systemic coagulation, and fibrinolytic activation are associated with pre-term delivery and low APGAR score in intrahepatic cholestasis of pregnancy.
abstract: OBJECTIVE
  This study was designed for evaluating coagulation parameters and low APGAR scores in pregnancies with intrahepatic cholestasis of pregnancy (ICP) vs. normal control pregnancies.
  
  
  METHODS
  We carried out a prospective case-control study by enrolling 40 women with ICP at the third trimester of pregnancy and 40 pregnant women without ICP.
  
  
  RESULTS
  Total bile acid levels (TBA), MPV, D-dimer, and umbilical artery systolic/diastolic ratio (UASDR) values were higher in women with ICP. Pregnancies complicated by low APGAR score exhibited significantly higher D-dimer levels than those of unimpaired fetal outcome in patients with ICP and control subjects. Levels of D-dimer were inversely correlated with 5'-Apgar score and positively associated with UASDR values in patients with ICP. Pregnancies that exhibited abnormal UASDR had higher total bile acid (TBA), D-dimer, MPV values and lesser 5'-Apgar score. In linear stepwise regression analyses, D-dimer independently and positively associated with UASDR, inversely associated with 5'-Apgar score in subjects with ICP; positively associated with mean platelet volume (MPV) values and inversely associated with 5'-Apgar score in all subjects.
  
  
  CONCLUSIONS
  Patients with ICP had low-grade systemic coagulation and fibrinolytic activation as evidenced by elevated D-dimer, and also D-dimer is associated with lower APGAR scores in both ICP and all pregnancies. Increased D-dimer levels suggest that hematological parameters could be potentially used as indicators of risk factor for assessing low APGAR score in ICP.
authors.affiliation: Department of Obstetrics and Gynecology, Izmir Aegean Obstetrics and Gynecology Teaching Hospital, Izmir, Turkey.
authors.forename: Ayse G
authors.initials: AG
authors.lastname: Kebapcilar
authors.forename: Cuneyt E
authors.initials: CE
authors.lastname: Taner
authors.forename: Levent
authors.initials: L
authors.lastname: Kebapcilar
authors.forename: Giray
authors.initials: G
authors.lastname: Bozkaya
mesh_terms: D000328:Adult; D001034:Apgar Score; D001647:Bile Acids and Salts / Q000097:blood; D001791:Blood Platelet Disorders / Q000150:complications*; D016022:Case-Control Studies; D002780:Cholestasis, Intrahepatic / Q000097:blood / Q000150:complications*; D004211:Disseminated Intravascular Coagulation; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic; D011446:Prospective Studies; D011673:Pulsatile Flow; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000000981:diagnostic imaging; D055815:Young Adult
chemical_list: D001647:Bile Acids and Salts; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D