Role of serum organic solute transporter alpha/beta and sodium taurocholate cotransporting polypeptide in intrahepatic cholestasis of pregnancy

Objectives: This study aimed to assess the role of OST-α, OST-β and NTCP in patients with ICP, with a view to determine patients with severe prognosis and to minimize adverse fetal outcomes. Material and methods: Sixty-nine pregnant women diagnosed with ICP and 50 healthy women were included the study. Serum OST-α, OST-β and NTCP were measured using ELISA kits. Results: The median OST-α levels were 176.3 pg/mL in women with ICP and 201 pg/mL in healthy subjects (p = 0.205). The median OST-β levels were found to be 51.17 pg/mL in patients with ICP and 40.9 pg/mL in controls (p = 0.033). Median NTCP levels were 519.7 ng/mL in the ICP group and 483.3 ng/mL in healthy women (p = 0.051). Conclusions: This is the first study to evaluate serum levels of OST-α, OST-β and NTCP in patients with ICP. It is likely that OST-α, OST-β and NTCP contribute to the etiopathogenesis of ICP. Serum OST-α and OST-β levels can be used as diagnostic and monitoring markers of ICP, and the inhibition of these molecules could provide therapeutic benefit in ICP by reducing the circulation of enterohepatic bile acids

The Relationship between Nifedipine and Postpartum Blood Loss in Patients with Preterm Labor

Background: The purpose of the study, to determine whether exposure to nifedipine before delivery is associated with an increased risk of postpartum blood loss in patients with preterm labor. Methods: This was a retrospective study screening a total of 486 patients who were admitted due to preterm labor from 2012 to 2019. Patients who were given nifedipine for tocolysis before delivery were considered as the study group (n: 240), and the patients who gave birth without getting tocolysis were considered as the control group (n: 246). The dose of nifedipine used during the last 24 hours, 72 hours and 1 week before delivery, the total dose of nifedipine given and the duration from the last dose to the delivery were recorded separately. Hemoglobin and hematocrit and platelet values measured before and 6 hours after delivery were recorded and postpartum bleeding amount was calculated. Results: No significant difference is observed in terms of mean difference between pre/postpartum hemoglobin and hematocrit levels between control group and nifedipine group (p > 0.05). But when subgroups that are created according to the time of use of nifedipine before delivery, a positive correlation was observed between difference in hemoglobin and hematocrit levels between prepartum and postpartum and nifedipine dosage for the last 24 hours (r = 0.176, p = 0.006), (r = 0.139, p = 0.030), but not for 72 hours or one week. Conclusions: The use of nifedipine in patients with preterm labor for tocolysis may be associated with increase in postpartum blood loss in the last 24 hours before delivery

The effectiveness of small heterodimer partner and FGF 19 levels in prediction of perinatal morbidity in intrahepatic cholestasis of pregnancy

© 2022 Informa UK Limited, trading as Taylor & Francis Group.Fibroblast growth factor 19 (FGF19) and small heterodimer partner (SHP) are molecules responsible for controlling serum bile acid levels. We designed this study for evaluating the effects of FGF 19 and SHP in intrahepatic cholestasis of pregnancy (ICP). Fifty-six pregnant women having ICP and 20 healthy pregnant women were included in the study. The patients were followed up until delivery in terms of pregnancy-related morbidity/mortality. Serum FGF 19 and SHP levels were determined by enzyme-linked immunosorbent assay (ELISA). Serum FGF 19 and SHP levels were significantly higher in the patient group compared to the control group (p:.04, p:.003, respectively). In ROC analysis, SHP level above 1995 ng/L was found effective in predicting the need for neonatal intensive care unit (ICU) follow-up with 53.8% sensitivity and 77.8% specificity. High SHP levels were correlated with perinatal morbidity, mortality and neonatal ICU hospitalisation.Impact StatementWhat is already known on this subject? Itching, elevated serum transaminase and serum total bile acid (TBA) levels are the most important clinical and biochemical findings of intrahepatic cholestasis of pregnancy (ICP). Fibroblast growth factor 19 (FGF19) and small heterodimer partner (SHP) are molecules–responsible for controlling serum bile acid levels. ICP is associated with preterm labour, asphyxia, foetal distress, stillbirth and preeclampsia. What do the results of this study add? Serum FGF 19 and SHP levels were significantly higher in the patient group compared to the control group. High SHP level was found effective in predicting the need for neonatal intensive care unit and showed a negative correlation with birth week and birth weight. What are the implications of these findings for clinical practice and/or further research? Checking SHP levels can help to predict perinatal mortality and morbidity. Treatments to be developed through the mechanism of action of FGF 19 and SHP can be promising in the treatment of ICP and other cholestatic liver diseases

Perinatal outcomes of intrauterine transfusion for foetal anaemia due to red blood cell alloimmunisation

The aim of this study was to evaluate the maternal and neonatal outcomes of patients who underwent intrauterine transfusion (IUT) for foetal anaemia due to red blood cell alloimmunisation and to determine the factors that affected the outcomes. All pregnancies that were treated with IUT due to Rh immunisation between January 2015 and June 2018 in the Kanuni Sultan Suleyman Training and Research Hospital, Department of Obstetrics and Gynaecology, were evaluated retrospectively. IUT due to non-Rh alloimmunisation, parvovirus B19 infection, chronic fetomaternal haemorrhage and foetal anaemia due to homozygous alpha-thalassemia were not included in the study. The perinatal and neonatal outcomes of the patients were retrospectively analysed. The gestational age, ultrasonography findings before and after IUT, laboratory results, complications related to IUT, and data on the newborns were recorded. The cases were divided into two groups, those with complication and those without complications, and their perinatal outcomes were compared. A total of 110 IUTs were performed in 42 foetuses. The survival rate after transfusion was 80.95%. Procedure-related complications were found in 12.7% of cases. There were no significant differences between the demographic and clinical characteristics of the patients with and without complications. The survival rate was lower and perinatal mortality was higher in foetuses with hydrops fetalis. IUT is a safe and effective procedure that can be used in the treatment of foetal anaemia in experienced centres. Survival rates can be increased by referring patients to experienced perinatology centres, by improving the IUT technique, and by reducing technique-related complications.Impact statement What is already known on this subject? The predominant use of IUT is to treat foetal anaemia due to red blood cell alloimmunisation. Despite the decrease after anti-D immune globulin prophylaxis, Rh immunisation is still a major cause of foetal anaemia. However, foetal survival rates have increased with the use of IUT. What do the results of this study add? The survival rates were increased after the development of a high-resolution ultrasound. Because foetal monitoring can be performed by ultrasonography, cord accidents and overload findings can be detected during transfusion, which allows for early interventions and increases survival rates