Dissertation
Dissertation > Medicine, health > Obstetrics and Gynaecology > Obstetrics > Pathological pregnancy ( abnormal pregnancy )

Study of Fetal Brain Hypoxic Injury in Intrahepatic Cholestasis of Pregnancy

Author ChenZuo
Tutor ZhangLiJuan
School Central South University
Course Obstetrics and Gynaecology
Keywords intrahepatic cholestasis of pregnancy oxygen deficiency brain injury the blood flow of fetal cerebral artery total bile acid
CLC R714.2
Type Master's thesis
Year 2007
Downloads 52
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Objective: This paper studied the relation with bile acid levels and fetal hypoxia and brain injury in ICP by measuring the blood flow changes of fetals cerebral artery in ICP with Color Doppler and detecting TBA levels in maternal blood and TBA, pH, lactate, NSE as well as NPBI levels in umbilical arterial blood. So we could reduce the fetal brain injury incidence in ICP by early prediction of fetal distress.Mothods: From May.2006 to Sep.2006, we selected 20 cases of patients with ICP for treatment as the study group in our hospital and randomly selected 20 cases of normal pregnant women for delivery as the control group during the same period. We used the Color Doppler ultrasound machine Sequia512 to measure the peak systolic velocity to end-diastolic velocity (S/D) and the resistive index (RI) of fetal middle cerebral artery. We used the automatic biochemical analyzer to detect the total bile acid (TBA) in maternal blood and TBA, pH as well as lactate in umbilical arterial serum. We used ELSIA assay to detect neuron-specific enolase (NSE) in umbilical artery serum. We used Bleomycin assay to detect nonprotein bound iron(NPBI) in umbilical arterial plasma.Results:(1) The TBA concentration in maternal blood of the study group (47.59±15.42) was significantly higher than that of the control group(3.77±1.49). The difference was statistically significant(P<0.01). The TBA concentration in newborn umbilical artery of the study group(11.17±3.55) was significantly higher than that of the control group (5.54±1.45). The difference was statistically significant (P<0.01).(2) In the study group the TBA concentration in maternal blood and that in umbilical artery were positively correlated. The coefficient correlation was r=0.937, P<0.01.(3) The pH value in newborn umbilical artery of the study group (7.21±0.03) was significantly lower than that of the control group(7.25±0.02). The difference was statistically significant(P<0.01). The S/D value (3.81±0.19) and RI value (0.67±0.06) of fetal middle cerebral artery of the study group were both significantly lower than those of the control group which were (4.34±0.58) and (0.75±0.07). The differences were statistically significant. The values of P respectively were (P<0.01) and (P<0.05). The lactate concentration in newborn umbilical artery of the study group (3.59±0.53) was significantly higher than that of the control group (2.46±0.41). The difference was statistically significant (P<0.01).(4) The NSE concentration (9.02±0.40) and NPBI concentration (0.86(0.96)) in newborn umbilical artery of the study group were significantly higher than that of the control group which were (8.16±0.30) and (0.00(0.55)). The difference was statistically significant(P<0.01).(5)In the study group the NSE concentration was positively correlated with TBA and lactate concentration in newborn umbilical artery. The NSE concentration was negatively correlated with the S/D and RI values of fetal middle cerebral artery and the pH value in newborn umbilical artery. The coefficient correlation respectively werer r=0.925,P<0.01; r=0.726,P<0.01; r=-0.802,P<0.01;r=-0.643,P<0.01 ;r=-0.575,P<0.01. The NPBI concentration was positively correlated with TBA and lactate concentration in the study group. The NPBI concentration was negatively correlated with the S/D,RI and pH value. The coefficient correlation respectively were r=0.511,P<0.05; r=0.632,P<0.01; r=-0.491,P<0.05 ;r=-0.465,P<0.05; r=-0.478, P<0.05.(6)The rates of premature birth, fetal distress and meconium-stained amniotic fluid, neonatal asphyxia, low birth weight infants in the study group were 35%,40%,45%,20%,20%. Those incidences in the control group were 0,5%,15%,0,0. Those values in two groups were statistically significant (P<0.01,P<0.01,P<0.05,P<0.05,P<0.05).Conclusion:(1)The bile acid concentrations in maternal blood and newborn umbilical artery of ICP were raised. Both were positively correlated. The NSE and NPBI concentrations in newborn umbilical artery were positively correlated with the bile acid level in newborn umbilical artery. Those indicated the existence of brain injury in fetus of ICP. High concentration of bile acid may be the reason of fetal brain hypoxic injury in ICP.(2)In ICP the pH value in newborn umbilical artery and the S/D and RI values of fetal middle cerebral artery decreased. The lactate concentration increased in ICE Those indicated that the fetus of ICP have hypoxia and metabolic acidosis.(3) The NSE and NPBI concentrations in newborn umbilical artery were negatively correlated with the pH, S/D and RI values. The NSE and NPBI concentrations were positively correlated with the lactate levels. Those indicated that fetal hypoxia are closely related with fetal brain injury in ICP.

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