morphine and Pruritus

Obstetric cholestasis is associated with maternal morbidity and adverse foetal outcomes. No information on local incidence is available. We present our experience with eight consecutive cases of obstetric cholestasis diagnosed between January 2003 and December 2005 in a regional hospital in Hong Kong. Three patients presented with pruritus without rash, three with impaired liver function, and two with elevated blood pressure postpartum. Meconium-stained liquor was present in five patients and four had spontaneous preterm delivery (between 34 and 36 weeks). The higher the bile acid level, the more marked the prematurity (correlation coefficient, -0.771; P=0.025). All those presenting with itchiness delivered preterm. Two patients developed pre-eclampsia. The rates of labour induction and abdominal delivery were both 38%. Heightened awareness among clinicians is required to recognise patients with obstetric cholestasis. Affected pregnancies are associated with meconium passage and prematurity. In our locality, affected women may also have an increased risk of pre-eclampsia. In affected women, the bile acid level is useful in assessing the risk of prematurity.

Topics: Adult; Bile Acids and Salts; Cesarean Section; Cholestasis, Intrahepatic; Female; Hong Kong; Hospitals; Humans; Hypertension; Incidence; Infant, Newborn; Liver Function Tests; Meconium; Obstetric Labor, Premature; Postpartum Period; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Premature Birth; Pruritus

The study was designed to investigate obstetric risk factors and pregnancy outcome of patients with pruritic urticarial papules and plaques of pregnancy (PUPPP).. A population-based study comparing all pregnancies of women with and without PUPPP was conducted. Deliveries occurred during the years 1988-2002 at the Soroka University Medical Center. A multivariable logistic regression model was constructed in order to find independent risk factors associated with PUPPP.. During a 15-year period, 159 197 deliveries took place. PUPPP complicated 42 (0.03%) of all pregnancies. Using a multivariable analysis, the following conditions were significantly associated with PUPPP: multiple pregnancies (odds ratio (OR) = 4.9, 95% confidence interval (CI) 1.7-14.1), hypertensive disorders (OR = 2.2, 95% CI 1.1-4.7), and induction of labor (OR = 7.6, 95% CI 4.0-14.5). Higher rates of 5-minute Apgar scores lower than 7 (OR = 8.0, 95% CI 4.4-14.9) and of cesarean deliveries (OR = 2.9, 95% CI 1.5-5.6) were noted in the PUPPP as compared to the comparison group. While investigating other perinatal outcome parameters such as oligohydramnios, intrauterine growth restriction, meconium-stained amniotic fluid and perinatal mortality, no significant differences were observed between the groups.. Pruritic urticarial papules and plaques of pregnancy is a condition significantly associated with multiple pregnancies, hypertensive disorders, and induction of labor. Perinatal outcome is comparable to pregnancies without PUPPP.

Topics: Adult; Apgar Score; Cesarean Section; Female; Fetal Growth Retardation; Humans; Hypertension; Infant, Newborn; Logistic Models; Meconium; Obesity; Odds Ratio; Oligohydramnios; Parity; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pruritus; Risk Factors; Urticaria

Topics: Adult; Amniotic Fluid; Birth Weight; Cholecystectomy; Cholecystography; Cholelithiasis; Cholestasis; Female; Follow-Up Studies; Gallbladder Diseases; Humans; Infant, Newborn; Jaundice; Liver Function Tests; Meconium; Middle Aged; Pregnancy; Pregnancy Complications; Pruritus

Topics: Amniotic Fluid; Asphyxia Neonatorum; Birth Weight; Cholestasis; Female; Fetal Death; Follow-Up Studies; Gestational Age; Hepatitis A; Humans; Infant, Newborn; Infant, Newborn, Diseases; Jaundice; Male; Maternal-Fetal Exchange; Meconium; Obstetric Labor Complications; Pregnancy; Pregnancy Complications; Pregnancy Complications, Infectious; Pruritus; Recurrence