Pregnancy-associated plasma protein a levels are decreased in obstetric cholestasis.

OBJECTIVE: Obstetric cholestasis is a cholestatic disease usually commencing in the third trimester of pregnancy and characterized by pruritus, elevation of liver enzymes, and increase in bile acids. The objective of this study was to compare the first trimester serum indicators of obstetric cholestasis with normal pregnancies. MATERIALS AND METHODS: Thirty-five patients diagnosed with obstetric cholestasis in a three-year period with first trimester biochemical assessment available were included in the study. Seventy patients with concordant pregnancy weeks, matched-age normal pregnancies were included as the control group. Pregnancy-associated plasma protein A (PAPP-A) and free beta-human chorionic gonadotropin (beta-hCG) levels were analyzed. RESULTS: No difference was observed between the two groups in terms of age and week of pregnancy. While the mean PAPP-A level was 0.76 ± 0.31 multiples of the medians (MoM) in the obstetric cholestasis group, it was determined to be 1.5 ± 0.84 in the control group (p = 0.0001). Among the two groups, the hCG levels were found to be higher in the obstetric cholestasis group (1.2 ± 0.79 MoM vs. 0.98 ± 0.53, p = 0.041). CONCLUSION: In this study, the first trimester PAPP-A levels in the obstetric cholestasis cases were found to be significantly lower than the control group. Low PAPP-A levels should be a warning for obstetric cholestasis.

Two-year experience of obstetric cholestasis: outcome and management.

PURPOSE: Our aim was to evaluate the management and outcome of obstetric cholestasis in our perinatology unit. METHODS: We analyzed 44 pregnant women complicated by cholestasis. Data were collected retrospectively. Details of patient demographics and outcomes of pregnancy were recorded. Patients were randomized due to their decision to take ursodeoxycholic acid (UDCA) therapy or not. RESULTS: Forty-four women of age 28.09 +/- 4.6 years delivered 45 newborns. The mean gestational age at diagnosis of obstetric cholestasis was 32.36 +/- 3.75 weeks. The mean delivery time was 38.25 +/- 1.5 weeks. Spontaneous premature delivery occurred in five (11.4%) of the patients. No stillbirths were observed. Serum transaminases decreased significantly in 26 of the patients who were treated with oral UDCA therapy. Twelve (27.2%) babies were admitted to the neonatal intensive care unit (NICU). Out of 12 mothers whose babies were admitted to NICU, nine patients had not received UDCA (p = 0.07). CONCLUSION: UDCA is effective in lowering transaminases.

Effectiveness of emergency cervical cerclage in patients with cervical dilation in the second trimester.

OBJECTIVE: Efficacy of emergency cerclage commensed in the second trimester is a controversial issue. In this study, we aimed to assess the success and associated complications of emergency cerclage in patients with cervical dilatation in the second trimester. MATERIAL AND METHODS: In this retrospective study, medical records of 75 pregnant women who had clinically and ultrasonographically confirmed cervical dilatation in the second trimester who had undergone cervical cerclage were analyzed. Pregnancy prolongation was the main outcome measure. RESULTS: Seventy-five women were included to the study. Mean age was 27 and mean gravidity of the patients was three. Mean cervical length was 28.5 mm (12-41 mm). The rate of spontaneous abortion, immature deliveries, prematurity and deliveries after 34 weeks were 2.7% (n = 2), 8% (n = 6), 12 (n = 9) and 77.7 (n = 58), respectively. Fetal survival rate was 89.1% (n = 65). Serious vaginal bleeding from the suture area was noted in two patients (2.6%). No postoperative complications occurred. CONCLUSION: Emergency cerclage is a simple surgical procedure with lower complication rates and can effectively prolong gestation to viability. It can be considered as a useful measure for patients with evidence of cervical changes in the second trimester.