目的:总结现有证据,为妊娠期肝内胆汁淤积症的诊断和治疗提出建议。
方法:妊娠肝内胆汁淤积症患者。
方法:使用空腹或非空腹胆汁酸诊断病情,对疾病严重程度进行分类,确定提供什么治疗,建立如何监测产前胎儿健康,确定何时进行选择性分娩。
结果:妊娠肝内胆汁淤积症患者的不良围产期结局风险增加,包括早产,新生儿呼吸窘迫和新生儿重症监护病房入院,当胆汁酸水平≥100μmol/L时,死产风险增加。胆汁酸检测的可用性和及时获得结果存在不公平,随着如何治疗的不确定性,监视器。并最终分娩这些怀孕。优化诊断和管理方案可以改善母婴产后结局。
方法:Medline,PubMed,Embase,和Cochrane图书馆从开始到2023年3月进行搜索,使用医学主题词(MeSH)和与怀孕相关的关键词,妊娠期肝内胆汁淤积症,胆汁酸,瘙痒,熊去氧胆酸,和死产。本文件对证据进行了抽象,而不是方法上的审查。
方法:作者使用建议分级评估对证据质量和建议强度进行了评估,开发和评估(等级)方法。见附录A(表A1定义和A2解释)。
■产科护理提供者,包括产科医生,家庭医生,护士,助产士,母胎医学专家,和放射科医生。
■妊娠期肝内胆汁淤积症需要非空腹胆汁酸水平的充分诊断,以指导最佳管理和分娩时机。
OBJECTIVE: To summarize the current evidence and to make recommendations for the diagnosis and management of intrahepatic
cholestasis of pregnancy.
METHODS: Pregnant people with intrahepatic
cholestasis of pregnancy.
METHODS: Diagnosing the condition using fasting or non-fasting bile acids, classifying disease severity, determining what treatment to offer, establishing how to monitor for antenatal fetal wellbeing, identifying when to perform elective birth.
RESULTS: Individuals with intrahepatic
cholestasis of pregnancy are at increased risk of adverse perinatal outcomes including preterm birth, neonatal respiratory distress and admission to a neonatal intensive care unit, with an increased risk of stillbirth when bile acid levels are ≥100 μmol/L. There is inequity in bile acid testing availability and timely access to results, along with uncertainly of how to treat, monitor. and ultimately deliver these pregnancies. Optimization of diagnostic and management protocols can improve maternal and fetal postnatal outcomes.
METHODS: Medline, PubMed, Embase, and the Cochrane Library were searched from inception to March 2023, using medical subject headings (MeSH) and keywords related to pregnancy, intrahepatic
cholestasis of pregnancy, bile acids, pruritis, ursodeoxycholic acid, and stillbirth. This document presents an abstraction of the evidence rather than a methodological review.
METHODS: The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See Appendix A (Tables A1 for definitions and A2 for interpretations).
UNASSIGNED: Obstetric care providers, including obstetricians, family physicians, nurses, midwives, maternal-fetal medicine specialists, and radiologists.
UNASSIGNED: Intrahepatic
cholestasis of pregnancy requires adequate diagnosis with non-fasting bile acid levels which guide optimal management and delivery timing.