HEPATOPROTECTORS IN THE TREATMENT OF INTRAHEPATIC CHOLESTASIS OF PREGNANCY


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Hepatoprotective drugs are in considerable use in obstetric practice in the Russian Federation. Questioning of physicians in the survey “Epidemiology of drug use in pregnant women" has shown that ursodeoxycholic acid (UDCA), the only hepatoprotector that has an evidence basis for the safety of a fetus and efficacy in treating cholestatic diseases, is used relatively rarely (in 27.0% of cases) and, on the contrary, essential phospholipids and artichoke (Cynara scolymus) extract are in common use (56.6% and 62.3%, respectively). The timely use of UDCA in a daily dose of 15 mg/kg in pregnant women with intrahepatic cholestasis makes it possible to alleviate clinical symptoms and to reduce the frequency of obstetric and perinatal complications.

Full Text

Restricted Access

About the authors

E. Ushkalova

People’s Friendship University of Russia

Email: eushk@yandex.ru
Professor, MD Moscow

N. Chukhareva

V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology

Moscow

V. Kartseva

V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology

Moscow

References

  1. Pusl T., Beuers U. Intrahepatic cholestasis of pregnancy // Orphanet. J. Rare Dis. - 2007; 2: 26.
  2. Williamson C., Hems L., Goulis D. et al. Clinical outcome in a series of cases of obstetric cholestasis identified via a patient support group // BJOG. - 2004; 111: 676-81.
  3. Wikstrom Shemer E., Stephansson O., Thuresson M. et al. Intrahepatic cholestasis of pregnancy and cancer, immune-mediated and cardiovascular diseases: A population-based cohort study // J. Hepatol. - 2015; 63: 456-61.
  4. Reyes H. Sex hormones and bile acids in intrahepatic cholestasis of pregnancy // Hepatology. - 2008; 47: 376-9.
  5. Wanggren K., Sparre L., Wramsby H. Severe jaundice in early IVF pregnancy // Eur. J. Obstet. Gynecol. Reprod. Biol. - 2004; 112: 228-9.
  6. Royal College of Obstetricians and Gynaecologists. Obstetric cholestasis. Green-Top Guideline No 43. 2011.
  7. Saleh M., Abdo K. Consensus on the management of obstetric cholestasis: National UK survey // BJOG. - 2007; 114: 99-103.
  8. Рекомендации Института Американской гастроэнтерологической ассоциации по медикаментозному лечению заболеваний желудочнокишечного тракта у беременных // Клин. гастроэнтерол. и гепатол. - 2008; 1: 426-31.
  9. Ивашкин В.Т., Широкова Е.Н., Маевская М.В. и др. Клинические рекомендации Российской гастроэнтерологической ассоциации и Российского общества по изучению печени по диагностике и лечению холестаза // Рос. журн. гастроэнтерол., гепатол., колопроктол. - 2015; 2: 41-57.
  10. Николаева А.В. Оптимизация тактики ведения беременных с внутрипе-ченочным холестазом с применением плазмафереза. Дис.. канд. мед. наук. М., 2009; 143 с.: ил.
  11. Успенская Ю.Б. Современное состояние проблемы холестаза беременных // Проблемы женского здоровья. - 2013; 8 (3): 70-6.
  12. Рациональная фармакотерапия в акушерстве, гинекологии и неонато-логии: Руководство для практических врачей. 2-е изд., испр. и доп. В 2 т. Т. 1. Акушерство, неонатология. Под общ ред. В.Н. Серова, Г.Т. Сухих / М.: Литтерра, 2010; 784 с.
  13. Недогода В.В., Скворцов В.В., Скворцова З.С. К вопросу о синдроме внутрипеченочного холестаза у беременных // Лечащий врач. - 2003; 6: 58.
  14. Ткачева О.Н., Бевз А.Ю., Ушкалова Е.А. и др. Первое Всероссийское фармакоэпидемиологическое исследование «Эпидемиология использования лекарственных средств у беременных»: основные результаты // Акушерство и гинекология. - 2011; 4: 112-7.
  15. Шефер К., Шпильман К., Феттер К. Лекарственная терапия в период беременности и лактации / М.: Логосфера, 2010.
  16. Lee N., Brady C. Liver disease in pregnancy // World J. Gastroenterol. -2009; 15: 897-906.
  17. Lata I. Hepatobiliary diseases during pregnancy and their management: An update // Int. J. Crit. Illn. Inj. Sci. - 2013; 3: 175-82.
  18. Briggs G., Freeman R., Yaffe S. Drugs in pregnancy and lactation. 9 ed. / Philadelphia, PA: Lippincott Williams & Wilkins, 2011.
  19. Christensen K., Andersen B., Vilstrup H. Primary sclerosing cholangitis with itching treated during pregnancy with ursodeoxycholic acid // Ugeskr. Laeger. -1997; 159: 7151-3.
  20. Goh S., Gull S., Alexander G. Pregnancy in primary biliary cirrhosis complicated by portal hypertension: report of a case and review of the literature // BJOG. - 2001; 108: 760-2.
  21. Rudi J., Schonig T., Stremmel W. Therapy with ursodeoxycholic acid in primary biliary cirrhosis in pregnancy // Z. Gastroenterol. - 1996; 34: 188-91.
  22. Akamatsu N., Sugawara Y. Primary biliary cirrhosis and liver transplantation // Intractable Rare Dis. Res. - 2012; 1: 66-80.
  23. Dilger K., Hohenester S., Winkler-Budenhofer U. et al. Effect of ursodeoxycholic acid on bile acid profiles and intestinal detoxification machinery in primary biliary cirrhosis and health // J. Hepatol. - 2012; 57: 133-40.
  24. Beuers U., Hohenester S., de Buy Wenniger L. et al. The biliary HCO(3)(-) umbrella: a unifying hypothesis on pathogenetic and therapeutic aspects of fibrosing cholangiopathies // Hepatology. - 2010; 52: 1489-96.
  25. Marschall H., Wagner M., Zollner G. et al. Complementary stimulation of hepatobiliary transport and detoxification systems by rifampicin and ursodeoxycholic acid in humans // Gastroenterology. - 2005; 129: 476-85.
  26. Rodrigues C., Marin J., Brites D. Bile acid patterns in meconium are influenced by cholestasis of pregnancy and not altered by ursodeoxycholic acid treatment // Gut. - 1999; 45: 446-52.
  27. Mazzella G., Rizzo N., Azzaroli F. et al. Ursodeoxycholic acid administration in patients with cholestasis of pregnancy: effects on primary bile acids in babies and mothers // Hepatology. - 2001; 33: 504-8.
  28. Geenes V., Lovgren-Sandblom A., Benthin L. et al. The reversed feto-maternal bile acid gradient in intrahepatic cholestasis of pregnancy is corrected by ursodeoxycholic acid // PLoS One. - 2014; 9: e83828.
  29. Gurung V., Middleton P., Milan S. et al. Interventions for treating cholestasis in pregnancy // Cochrane Database Syst. Rev. - 2013; 6: CD000493.
  30. Bacq Y., Sentilhes L., Reyes H. et al. Efficacy of ursodeoxycholic acid in treating intrahepatic cholestasis of pregnancy: a meta-analysis // Gastroenterology. - 2012; 143: 1492-501.
  31. Grand'Maison S., Durand M., Mahone M. The effects of ursodeoxycholic acid treatment for intrahepatic cholestasis of pregnancy on maternal and fetal outcomes: a meta-analysis including non-randomized studies // J. Obstet. Gynaecol. Can. - 2014; 36: 632-41.
  32. Zapata R., Sandoval L., Palma J. et al. Ursodeoxycholic acid in the treatment of intrahepatic cholestasis of pregnancy. A 12-year experience // Liver Int. - 2005; 25: 548-54.
  33. Zhou F., Gao B., Wang X., et al. Meta-analysis of ursodeoxycholic acid and S-adenosylmethionine for improving the outcomes of intrahepatic cholestasis of pregnancy // Zhonghua Gan Zang Bing Za Zhi. - 2014; 22: 299-304.
  34. Хлынов И., Чикунова М. Первичный билиарный цирроз: критерии диагностики и собственный опыт терапии // Врач. - 2015; 1: 44-6.
  35. Сарвилина И.В. Сравнительный клинико-экономический анализ применения препаратов урсодезоксихолевой кислоты у пациентов с желчнокаменной болезнью I стадии // Лечащий врач. - 2015; 2: 64-8.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies