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目的:探讨妊娠期肝内胆汁淤积症对围产儿预后的影响及终止妊娠方式的选择。方法:选择2009年10月-2011年10月在浙江省永康市妇女儿童医院分娩的60例妊娠期肝内胆汁淤积症患者作为观察组,选取同期住院的正常孕妇75例作为对照组,比较两组终止妊娠的方式及新生儿情况。结果:观察组的早产、胎儿窘迫、胎粪污染、新生儿窒息、剖宫产、产后出血明显高于对照组(χ2分别为13.42、10.42、4.02、25.53、34.83、4.61);观察组胎死宫内2例,而对照组无死亡;观察组孕妇血清总胆汁酸值不同对新生儿的影响不同,孕妇血清总胆汁酸≤20umol/L组的早产、胎儿窘迫、胎粪污染、新生儿窒息明显低于总胆汁酸>20umol/L组(χ2分别为7.18、8.69、4.53、4.74)。结论:妊娠期肝内胆汁淤积症对母婴,特别是新生儿的危害极大,且孕妇血清总胆汁酸值越高,发生早产、胎儿窘迫、胎粪污染的可能性越高,围产儿预后越差,产科医师应提高对妊娠期肝内胆汁淤积症的认识,把握好选择以剖宫产作为终止妊娠方式的时机。
Objective: To investigate the effect of intrahepatic cholestasis of pregnancy on the prognosis of perinatal and the choice of termination of pregnancy. Methods: From October 2009 to October 2011, 60 pregnant women with intrahepatic cholestasis who were delivered in Yongkang Women and Children’s Hospital of Zhejiang Province were selected as the observation group. 75 normal pregnant women were enrolled in the same period as the control group, Group termination of pregnancy and neonatal conditions. Results: The incidence of preterm birth, fetal distress, meconium contamination, neonatal asphyxia, cesarean section and postpartum hemorrhage in the observation group were significantly higher than those in the control group (χ2 = 13.42,10.42,4.02,25.53,34.83,4.61 respectively) Intrauterine in 2 cases, while the control group without death; observation group of pregnant women with different serum total bile acid value of different effects on newborns, maternal serum total bile acid ≤ 20umol / L group of preterm birth, fetal distress, meconium contamination, neonatal asphyxia Significantly lower than the total bile acid> 20umol / L group (χ2 were 7.18,8.69,4.53,4.74). Conclusion: Intrahepatic cholestasis of pregnancy is extremely harmful to maternal and infant, especially neonates. And the higher the total bile acid value of pregnant women, the higher the possibility of preterm birth, fetal distress and meconium contamination, the prognosis of perinatal The worse, obstetricians should raise awareness of intrahepatic cholestasis of pregnancy, to grasp the choice of cesarean section as the timing of termination of pregnancy.