Biochemical Parameters of the Intrahepatic Cholestasis of Pregnancy
Binder T.1, Zima T.2, Vítek L.2
1Gynekologicko-porodnická klinika 2. LF UK a FN Motol, Praha, přednosta doc. MUDr. L. Rob, CSc. 2Ústav klinické biochemie l. LF UK a VFN, Praha, přednosta prof. MUDr. T. Zima, DrSc. |
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Summary:
Setting: Department of Obstetrics and Gynecology, 2nd Medical School Charles University and Teaching
Hospital Motol, Prague, Department of Clinical Biochemistry, General Teaching Hospital and lst Medical
School Charles University, Prague.
Aim of the study: To asses the biochemical parameters of the intrahepatic cholestasis of pregnancy from
the viewpoint of their importance for establishmnet of the diagnosis, seriousness and progress of the illness
with special aspect of the possible compromise of the foetus. To asses if the examination of the serum
levels of serotonin could contribute the objectification of the seriousness of the skin pruritus.
Methodology: From January1999 till June 2005 at two Prague perinatology centres was the ICP diagnosed
in 269 from 29 890 pregnant women. In 78 of them the manifestation of the signs of illness was appreciated
as moderate or severe and they appeared before the finished 36th gestational week. These women
underwent the treatment. Of the biochemical parametres we monitored in these women the dynamic
serum values of AST, ALT, ALP, GMT and bilirubin in 7 day intervals. The serum levels of bile acids
were assessed at the beginning of the treatment and at the time of labour. We also assessed the serum
levels of bile acids in cord blood immediately after the labour. In 22 women with ICP we monitored the
serum levels of serotonin and ALP isomers. The control suite comprised 20 healthy pregnant women.
Results: In severe cases the serum levels of AST and ALT reached even 50 multiple of regular values and bile
acids values cross over 100 μmol/l. The serum levels of bilirubin, GMT and ALP were statistically significantly
elevated compared with controls. The serum levels of serotonin did not differ from the levels of the
controls. The incidence of severe cases did not reached even 5% of ICP, moderate cases occurred in 25%.
Conclusions: For the precise assignment diagnosis and prognosis of the illness ICP with the aspect on the
foetus condition is the examination of the serum levels of bile acids essential. All monitored biochemical
parameters were positively influenced by the treatment with ursodeoxycholic acid. The exception represents
the total value of ALP which persists high untill the labour. Serotonin and its serum levels are not
applicable marker to the objectivization of the seriousness of the skin pruritus.
Key words:
Key words: intrahepatic
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