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Colestase gestacional : estudo observacional num centro terciário português
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Introdução: A colestase gestacional (CG) acarreta riscos fetais relevantes, como morte fetal e parto pré-termo (PPT). O diagnóstico é estabelecido com achados clínicos (prurido palmo-plantar) e doseamento elevado de ácidos biliares (AB).
Objetivos e Métodos: Estudo retrospetivo descritivo que pretende caracterizar a população de grávidas com diagnóstico de CG e com parto no CHULN-HSM no período entre 1 de Janeiro de 2020 e 31 de Julho de 2023, avaliar a condução clínica destas gestações e avaliar o impacto da CG, em termos de intercorrências/complicações obstétricas e neonatais.
Resultados: A coorte inclui 43 gestações e 51 nascimentos (0,5% do total de partos). A maioria das grávidas possuía nacionalidade portuguesa, era nulípara e tinha excesso de peso. A maior parte foi diagnosticada no terceiro trimestre (93%) – 2/3 após as 34 semanas – com mediana de AB ao diagnóstico de 21,7 μmol/L. Correspondiam a CG grave 5% dos casos – todos diagnosticados antes das 36 semanas – a CG moderada 17,5% dos casos e a CG ligeira 77,5% dos casos. A maioria das grávidas (74,4%) foi tratada sintomaticamente com AUDC. Verificou-se em 67,4% dos casos necessidade de admissão hospitalar prévia ao parto, por CG. Ocorreu uma morte fetal (2%), em potencial relação com CG grave. A mediana da idade gestacional (IG) no parto foi 37 semanas, com taxa global de PPT de 30%, com IG mínima de 32 semanas, sendo a taxa de PPT iatrogénico por CG de 19%.
Conclusão: A prevalência estimada de CG nesta população (0,5%) parece sobreponível à descrita na literatura. Foi confirmada a elevada taxa de PPT e a possível ocorrência de morte fetal em casos graves. Reforça-se a importância da suspeição clínica de CG perante clínica sugestiva, instituindo vigilância obstétrica adequada. A uniformização nacional/internacional dos critérios diagnósticos e do momento mais adequado para programação do parto são desafios por atingir.
Introduction: Gestational cholestasis (GC) entails relevant fetal risks, such as fetal death and preterm birth (PTB). The diagnosis is established with clinical findings (palmar-plantar pruritus) and elevated levels of bile acids (BA). Objectives and Methods: A descriptive retrospective study aiming to characterize the population of pregnant women diagnosed with GC and delivering at CHULN-HSM between January 1, 2020, and July 31, 2023, to evaluate the clinical management of these pregnancies, and assess the impact of GC in terms of obstetric and neonatal complications. Results: The cohort includes 43 pregnancies and 51 births (0.5% of total births). Most pregnant women were Portuguese nationals, nulliparous, and overweight. The majority were diagnosed in the third trimester (93%) – 2/3 after 34 weeks – with a median BA at diagnosis of 21.7 μmol/L. Severe GC accounted for 5% of cases – all diagnosed before 36 weeks – moderate GC for 17.5% of cases, and mild GC for 77.5% of cases. Most pregnant women (74.4%) were symptomatically treated with UDCA. Hospital admission before delivery due to GC was necessary in 67.4% of cases. There was one fetal death (2%), potentially related to severe GC. The median gestational age (GA) at delivery was 37 weeks, with an overall PTB rate of 30%, with a minimum GA of 32 weeks, and the iatrogenic PTB rate due to GC was 19%. Conclusion: The estimated prevalence of GC in this population (0.5%) seems to overlap with that described in the literature. The high rate of PTB and the potential occurrence of fetal death in severe cases were confirmed. The importance of clinical suspicion of GC in the presence of suggestive symptoms, instituting adequate obstetric surveillance, is emphasized. National/international standardization of diagnostic criteria and the most appropriate timing for delivery scheduling are challenges yet to be met.
Introduction: Gestational cholestasis (GC) entails relevant fetal risks, such as fetal death and preterm birth (PTB). The diagnosis is established with clinical findings (palmar-plantar pruritus) and elevated levels of bile acids (BA). Objectives and Methods: A descriptive retrospective study aiming to characterize the population of pregnant women diagnosed with GC and delivering at CHULN-HSM between January 1, 2020, and July 31, 2023, to evaluate the clinical management of these pregnancies, and assess the impact of GC in terms of obstetric and neonatal complications. Results: The cohort includes 43 pregnancies and 51 births (0.5% of total births). Most pregnant women were Portuguese nationals, nulliparous, and overweight. The majority were diagnosed in the third trimester (93%) – 2/3 after 34 weeks – with a median BA at diagnosis of 21.7 μmol/L. Severe GC accounted for 5% of cases – all diagnosed before 36 weeks – moderate GC for 17.5% of cases, and mild GC for 77.5% of cases. Most pregnant women (74.4%) were symptomatically treated with UDCA. Hospital admission before delivery due to GC was necessary in 67.4% of cases. There was one fetal death (2%), potentially related to severe GC. The median gestational age (GA) at delivery was 37 weeks, with an overall PTB rate of 30%, with a minimum GA of 32 weeks, and the iatrogenic PTB rate due to GC was 19%. Conclusion: The estimated prevalence of GC in this population (0.5%) seems to overlap with that described in the literature. The high rate of PTB and the potential occurrence of fetal death in severe cases were confirmed. The importance of clinical suspicion of GC in the presence of suggestive symptoms, instituting adequate obstetric surveillance, is emphasized. National/international standardization of diagnostic criteria and the most appropriate timing for delivery scheduling are challenges yet to be met.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2024
Palavras-chave
Colestase gestacional Prurido Ácidos biliares Prematuro Gravidez Obstetrícia