Gebeliğin İntrahepatik Kolestazı
Özet
Gebeliğin intrahepatik kolestazı (GİK), genellikle gebeliğin ikinci veya üçüncü trimesterinde gelişen, kaşıntı ve serum safra asidi konsantrasyonunda artışla karakterize, gebeliğe özgü en yaygın karaciğer hastalığıdır. Etiyolojisinde genetik yatkınlık, hormonal etkiler ve çevresel faktörler rol oynar. Tipik belirtisi avuç içi ve ayak tabanlarında daha baskın olan, geceleri şiddetlenen kaşıntıdır. Hastalığın tanısı, başka bir karaciğer patolojisi olmaksızın, yüksek safra asitleri ve aminotransferaz seviyeleri ile kaşıntı varlığına dayanır. GİK, fetal klirensin tersine dönmesiyle fetüste safra asidi birikimine yol açarak intrauterin ölüm, mekonyumlu amniyotik sıvı, erken doğum ve yenidoğan solunum sıkıntısı sendromu gibi ciddi komplikasyon risklerini artırır. Tedavide maternal kaşıntıyı azaltmak için tercih edilen ajan ursodeoksikolik asittir (UDCA). Doğum zamanlaması, gebelik boyunca saptanan en yüksek safra asidi düzeylerine göre 36 ila 38. haftalar arasında planlanır, ancak dirençli vakalarda 36. haftadan önce de doğum düşünülebilir. Doğumdan sonra semptomlar ve laboratuvar değerleri hızla normale döner.
Intrahepatic cholestasis of pregnancy (ICP) is the most common pregnancy-specific liver disease, typically developing in the second or third trimester and characterized by pruritus and elevated serum bile acid concentrations. Its etiology involves a combination of genetic predisposition, hormonal influences, and environmental factors. The hallmark symptom is itching, which is predominant on the palms and soles and worsens at night. Diagnosis relies on the presence of pruritus associated with elevated bile acids and aminotransferases in the absence of other liver diseases. ICP leads to bile acid accumulation in the fetus due to reversed feto-maternal gradients, significantly increasing the risks of adverse fetal outcomes such as intrauterine death, meconium-stained amniotic fluid, preterm delivery, and neonatal respiratory distress syndrome. Ursodeoxycholic acid (UDCA) is the preferred treatment to reduce maternal pruritus. Delivery timing is managed based on the highest recorded bile acid levels during pregnancy, typically recommended between 36 and 38 weeks, though delivery before 36 weeks may be warranted in refractory cases. Symptoms and laboratory findings resolve rapidly following delivery.
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