scholarly journals Drug-Induced Liver Injuries as a Complication of Therapy Gestagens for Miscarriage

2021 ◽  
Vol 17 (28) ◽  
pp. 24-28
Author(s):  
I.A. Argunova ◽  
◽  
◽  
Keyword(s):  
Risk Factors ◽  
Pregnant Women ◽  
European Association ◽  
Clinical Case ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Drug Induced ◽  
Liver Injuries ◽  
Relationship Of ◽  
Cholestasis Of Pregnancy ◽  
Micronized Progesterone

An increase of liver function scores may be related to rarely diagnosed drug-induced liver injuries. Their frequency of pregnant women is increasing against the background of therapy of miscarriage with gestagens, which have potential heptotoxicity. The clinical case with the progression of acute hepatitis caused by the use of dydrogesterone and micronized progesterone was analyzed according to the criteria of the European Association for the Study of the Liver and the RUCAM scale, taking into account the physiological growth of alkaline phosphatase activity during gestation. The probability of drug damage to the liver, risk factors, variant, severity were determined. Typical mistakes in diagnosis and treatment are shown, recommendations are given on the use of hepatoprotectors in women with this pathology. An opinion about the genetic relationship of gestagen-induced liver damage and intrahepatic cholestasis of pregnancy and the need to create clinical guidelines for the management of pregnant women with drug-induced liver injuries was expressed

scholarly journals EVALUATION OF RISK FACTORS FOR INTRAHEPATIC CHOLESTASIS OF PREGNANCY IN PATIENTS PRESENTING TO A TERTIARY CARE CENTRE

2021 ◽  
Vol 71 (5) ◽  
pp. 1852-56
Author(s):  
Rabiah Anwar ◽  
Kashif Razzaq ◽  
Aysha Shahid ◽  
Afeera Afsheen ◽  
Amera Tariq ◽  
...  
Keyword(s):  
Risk Factors ◽  
Family History ◽  
Pregnant Women ◽  
Intrahepatic Cholestasis ◽  
Tertiary Care ◽  
Medical Illness ◽  
Care Hospital ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
History Of ◽  
Cholestasis Of Pregnancy

Objectives: To evaluate the principal risk factors associated with development of intrahepatic cholestasis of pregnancy (ICP) in patients presenting to a tertiary care hospital. Study Design: Case control study. Place and Duration of Study: Department of Gynaecology and Obstetrics, Pakistan Naval Ship Shifa Hospital Karachi, from Jan to Dec 2019. Methodology: All pregnant women with symptoms of intrahepatic cholestasis of pregnancy confirmed on history, examination and investigations were included. A comparison cohort of pregnant women with neither hepatobiliary nor medical illness associated with pregnancy was selected. Comparison of risk factors was done between both the groups. Results: Out of 6932 obstetric patients, 90 (1.29%) had intrahepatic cholestasis of pregnancy. Pruritis was cardinal symptoms in all (100%) the patients followed by excoriation marks (75.55%). Intrahepatic cholestasis of pregnancy was significantly found in women with multiple pregnancy (OR=1.81; 95% CI 0.51-6.42), antecedent intrahepatic cholestasis of pregnancy (OR=36.81; 95% CI 8.53-158.79), family history of intrahepatic cholestasis of pregnancy (OR=17.80; 95% CI 2.29-137.91) and history of pruritis with obstetric cholestasis of pregnancy use (OR=16.25; 95% CI 0.91-289.08). Conclusion: Intrahepatic cholestasis of pregnancy was observed in less than two percent cases. Risk of intrahepatic cholestasis of pregnancy was found to be increased with multiple pregnancies, antecedent intrahepatic cholestasis of pregnancy, family history of intrahepatic cholestasis of pregnancy and history of pruritis with prior obstetric cholestasis of pregnancy use.

scholarly journals Characterization of gut microbiota associated with clinical parameters in intrahepatic cholestasis of pregnancy

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Rong Li ◽  
Xuehai Chen ◽  
Zhongzhen Liu ◽  
Yan Chen ◽  
Chuan Liu ◽  
...  
Keyword(s):  
Gut Microbiota ◽  
Pregnant Women ◽  
Intrahepatic Cholestasis ◽  
Premature Delivery ◽  
Clinical Parameters ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Control Groups ◽  
And Control ◽  
Cholestasis Of Pregnancy

Abstract Background Intrahepatic cholestasis of pregnancy (ICP) is a liver disorder that specifically occurs in pregnancy. Elevated levels of liver transaminases aspartate aminotransferase, alanine aminotransferase and serum bilirubin levels are common biochemical characteristics in ICP. The disorder is associated with an increased risk of premature delivery and stillbirth. The characterization of the potential microbiota in ICP could go a long way in the prevention and treatment of this pregnancy disease. Methods A total of 58 patients were recruited for our study: 27 ICP patients and 31 healthy pregnant subjects with no ICP. The V3 and V4 regions of the 16S rDNA collected from fecal samples of both diseased and control groups were amplified. 16S rRNA gene amplicon sequencing was then performed on gut microbiota. Sequencing data were analyzed and the correlation between components of microbiota and patient ICP status was found. Related metabolic pathways, relative abundance and significantly different operational taxonomic units (OTUs) between ICP and controls were also identified. Results Elevated levels of total bile acid, ALT, AST, Dbil and Tbil were recorded or observed in ICP subjects as compared to the control. Gut microbiota in pregnant women was dominated by four major phyla and 27 core genera. PCoA analysis results indicated that there was no significant clustering in Bray–Curtis distance matrices. Our results showed that there was a correlation between specific OTUs and measured clinical parameters of pregnant women. Comparison at the different taxonomy levels revealed high levels of abundance of Blautia and Citrobacter in ICP patients. At the family level, Enterobacteriaceae and Leuconostocaceae were higher in ICP patients. 638 KEGG Orthologs and 138 pathways significantly differed in the two groups. PLS-DA model with VIP plots indicated a total of eight genera and seven species were key taxa in ICP and control groups. Conclusions Our research indicated that although there was no significant clustering by PCoA analysis, patients with ICP have increased rare bacteria at different phylogenetic levels. Our results also illustrated that all 638 KEGG Orthologs and 136 in 138 KEGG pathways were less abundant in ICP patients compared to the controls.

Association of ABCB4 and ABCB11 nucleotide variants with intrahepatic cholestasis of pregnancy

2019 ◽  
Vol 88 (4) ◽  
pp. 209-217
Author(s):  
Milena Gruszczyńska-Losy ◽  
Adrianna Mostowska ◽  
Łukasz Adamczak ◽  
Paweł Jagodziński ◽  
Ewa Wender-Ożegowska ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Intrahepatic Cholestasis ◽  
Clinical Symptoms ◽  
Melting Curve ◽  
Liver Disorder ◽  
Melting Curve Analysis ◽  
Control Group ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Increased Risk ◽  
Cholestasis Of Pregnancy

Background: Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disorder during gestation. The exact pathogenesis of ICP is multifactorial and still unclear. Therefore, our study aimed to check whether the selected ABCB4and ABCB11nucleotide variants are associated with an increased risk of ICP. Methods:ICP was diagnosed based on clinical symptoms characteristic of this disease and confirmed by increase in serum bile acids and transaminases, spontaneous resolution of clinical symptoms and normalization of laboratory tests after delivery. The total of 86 pregnant women meeting the criteria were included into the study. Healthy pregnant women with uncomplicated pregnancy served as control group (n=310). Sixcommon nucleotide variants in theABCB11and ABCB4genes were genotypedwith the use of high-resolution melting curve analysis. Conclusion:Our study did not show any significant association of analysed ABCB4and ABCB11nucleotide variants with the increased risk of intrahepatic cholestasis of pregnancy.

scholarly journals Comparative Proteomics Analysis of Placenta from Pregnant Women with Intrahepatic Cholestasis of Pregnancy

PLoS ONE ◽  
2013 ◽  
Vol 8 (12) ◽  
pp. e83281 ◽  
Author(s):  
Ting Zhang ◽  
Yueshuai Guo ◽  
Xuejiang Guo ◽  
Tao Zhou ◽  
Daozhen Chen ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Intrahepatic Cholestasis ◽  
Comparative Proteomics ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Proteomics Analysis ◽  
Cholestasis Of Pregnancy

scholarly journals Perinatal outcomes and intrahepatic cholestasis of pregnancy: a prospective study

2019 ◽  
Vol 8 (3) ◽  
pp. 1177
Author(s):  
Sangeeta Parihar ◽  
Swatantar Singh
Keyword(s):  
Pregnant Women ◽  
Intrahepatic Cholestasis ◽  
Postpartum Haemorrhage ◽  
Preterm Labour ◽  
Perinatal Outcomes ◽  
P Value ◽  
Maternal Outcomes ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Fetal Outcomes ◽  
Cholestasis Of Pregnancy

Background: Women with intrahepatic cholestasis of pregnancy (ICP) have an increased risk for postpartum haemorrhage, dyslipidaemia, preterm labour and operative interference. Fetus in ICP has been associated with an increased incidence of preterm labour, preterm prelabour rupture of membrane, fetal distress, abnormal CTG, meconium staining, spontaneous intrauterine death. The present study was done to evaluate the perinatal outcomes – maternal outcomes and fetal outcomes of ICP.Methods: This was a prospective observational study carried out in a tertiary care teaching hospital. Total 1100 pregnant women were screened during the study period. Patients with ICP were identified in maternity care units after eliciting history about itching. Pregnancies with pregnancy induced hypertension and other liver diseases in pregnancy were excluded.Results: 62 pregnant women with prevalence rate of 5.64% have been found to be suffering from ICP. The most frequently affected (22, 35.48%) age-group with ICP were belong to age > 35 years. A majority of pregnant women with intrahepatic cholestasis of pregnancy was of multipara. ICP was highly significantly associated with small for gestational age (SGA, p-value: 0.0003); abnormal cardiotocography (CTG, p-value: 0.0002); and meconium stained liquor (p-value: 0.0001). Caesarean section as mode of delivery found significantly associated (p-value: 0.0033) with ICP. Insomnia (p-value: 0.0045); dyslipidemia (p-value: 0.0011); and postpartum haemorrhage (p-value: 0.0122) were also found significantly with ICP.Conclusions: ICP can adversely affect fetal as well as maternal pregnancy outcomes. Maternal outcomes have good prognosis, but fetal outcomes can be improved by timely and effective intervention.

Psycho-emotional state of women with intrahepatic cholestasis of pregnant women after the use of assisted reproductive technologies

2020 ◽  
pp. 31-35
Author(s):  
O.G. Boychuk ◽  
◽  
T.V. Kolomiichenko ◽  
N.E.N. Ebae ◽  
◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pregnant Women ◽  
Intrahepatic Cholestasis ◽  
Comparison Group ◽  
Assisted Reproductive Technologies ◽  
Reproductive Technologies ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Psychoemotional State ◽  
Cholestasis Of Pregnancy

We can assume a deterioration in the psychoemotional state and a decrease in the quality of life in women after assisted reproductive technologies (ART) with intrahepatic cholestasis of pregnancy (ICP), but no scientific information was found on this issue. The objective: to assess the psychoemotional state of pregnant women with ICP after using ART. Materials and methods. We examined 40 pregnant women after ART with the manifestations of ICP (main group) and 40 – without the manifestations of ICP (comparison group). The presence of vegetative dysfunction syndrome was assessed (according to A.M. Wayne); quality of sleep, especially falling asleep and waking up (A.M. Vein, Yu.I. Levin); anxiety level using the test Spielberg in the modification by Hanin, the presence and severity of depression on the Beck scale; quality of life according to the questionnaire SF-36. The data were processed by methods of variation statistics. Results. In pregnant women after ART with ICP, the total number of points on the A.M. Vein questionnaire is 3.5 times higher than the threshold value of 15 points (median 52 [45, 60] points versus 36 [28; 45] points in the absence of ICP, p<0.05). 80.0% of these women reported sleep disorders. The incidence of significant sleep quality disturbances is 37.5%. Patients demonstrate a higher median level of both personal and situational anxiety. Manifestations of depression were noted in 55.0% patients against 27.5% in the comparison group (p<0.05). Women with ICP have lower ratings for their quality of life, both on physical and psychological health scales. The decrease in the integral indicator of physical health (70 [58; 89] versus 84 [75; 92], p<0.05) is a reflection of the physical discomfort associated with ICP. Conclusions. After using ART, women with ICP need to assess the vegetative and psychoemotional state, correct the revealed disorders to normalize the quality of life, and achieve positive perinatal outcomes. Keywords: assisted reproductive technologies, intrahepatic cholestasis of pregnancy, vegetative dysfunction syndrome, anxiety, depression, quality of life.

Prospects of the treatment of preterm labor by the use of sublingual forms of micronized progesterone

2016 ◽  
pp. 28-32
Author(s):  
G.I. Reznichenko ◽  
◽  
N.Yu. Reznichenko ◽  
V.Yu. Potebnya ◽  
I.L. Antonyuk ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pregnant Women ◽  
Preterm Labor ◽  
Total Bilirubin ◽  
Antenatal Clinic ◽  
Premature Births ◽  
Complex Treatment ◽  
Delayed Treatment ◽  
Threatened Preterm Labor ◽  
Micronized Progesterone

The objective: to determine the efficacy of sublingual forms of micronized progesterone (Luteina) in treatment of women with preterm labor. Patients and methods. 45 women with preterm labor were examined in 24–35 weeks of gestation. 2 subgroups were formed. Subgroup Ia consisted of 23 women, who received micronized progesterone sublingually in complex treatment, subgroup IB consisted of 22 pregnant women, who didn’t receive progesterone. 56 case reports of premature births were analyzed retrospectively. The main group of pregnant women underwent general and biochemical examination, determination of ALT, AST, total bilirubin and progesterone. Results. Risk factors for preterm labor during observation in the antenatal clinic were established. They included the underestimation of anamnesis, incomplete examination, delayed treatment of threatened preterm labor, insufficient prevention of complications of pregnancy. It was established that the levels of both AST and ALT as well as total bilirubin in serum hadn’t change after the treatment in both subgroups of women from I group. The decrease in the serum level of progesterone was observed in both subgroups. Average concentration of progesterone in blood serum increased up to 1108±39 nmol/l on the third day of treatment in the subgroup Ia, and it reached 1260±42 nmol/l on the seventh day, whereas its dynamics practically didn’t chang in subgroup IB (882±33 nmol/l and 893±31 respectively). The use of sublingual form of micronized progesterone in the complex treatment of women with preterm labor gave the opportunity 2 times to decrease frequency of premature births, 1.5 times to decrease frequency of delivery complications, almost 2.5 to improve perinatal consequences compared to subgroup of women who hadn’t use progesterone. Conclusions. 1. Risk factors of preterm labor are delayed first prenatal visit of pregnant women to antenatal clinic, the underestimation of anamnesis and risk factors for the development of gestational complications, incomplete examination, delayed treatment of threatened preterm labor, incomplete prevention of pregnancy complications. 2. The use of sublingual forms of micronized progesterone in cases of signs of preterm labor permits to restore quickly the level of progesterone in blood serum to physiological parameters, 2 times to decrease the frequency of premature births and 2.5 times to decrease perinatal consequences in infants. 3. The use of sublingual form of micronized progesterone in pregnant women with preterm labor does not affect the function of the liver. 4. The obtained results allow to recommend the wide use of sublingval form of micronized progesterone to pregnant women with preterm labor. Key words: preterm labor, treatment, Luteina.

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