Treatment of obstetric cholestasis with polyunsaturated phosphatidylcholine and ursodeoxycholic acid

Abstract

Abstract Objective: Analysis of obstetric outcomes and laboratory results depending on blood serum level of bile acids (BA) in patients with obstetric cholestasis before treatment. Material and methods: The study was conducted among 43 pregnant women with obstetric cholestasis. The study population was divided into 3 groups, depending on blood serum level of bile acids before treatment: I group (n=15) – BA 11-15μmol/l, II group (n=13) – BA 15-20μmol/l and III group (n=15) – BA > 20μmol/l. Polyunsaturated phosphatidylcholine (PPC) treatment was used in I group, ursodeoxycholic acid (UDCA) in II group and combination of them in III group. Blood serum levels of transaminases, alkaline phosphatase and bilirubin were determined before treatment and during delivery. Bile acids concentrations were also assessed during delivery in maternal serum and cord blood. Results: No significant statistical difference was observed in patients age, number of primiparas, delivery method, neonatal birth weight and Apgar score. The earliest obstetric cholestasis diagnosis was observed in III group. Earlier pregnancy termination, higher transaminases and bile acids levels before treatment, larger differences (Δ) of transaminases and bile acids levels before treatment and during delivery as well as larger Δ in bile acids levels before treatment and in cord blood during delivery were observed in III group in comparison to I group. Conclusions: It seems that combined therapy with UDCA and PPC could be considered in obstetric cholestasis, especially in case of its early onset and/or severe course.