Fetal complications of obstetric cholestasis.

Abstract

sodium cromoglycate. This effect was not due to a difference between the patients, since when we recalculated the results using the same 11 subjects for both placebo and sodium cromoglycate they were the same. Sodium cromoglycate has a slight phosphodiesterase inhibiting effect, which might explain the differences' 0; however, it has no effect on the histamine response of human bronchial smooth muscle.' We have also shown that sodium cromoglycate has no effect on tracheal smooth-muscle contraction induced by histamine or methacholine."1 It does, however, inhibit allergen contraction of the passively sensitised human tracheal smooth muscles.Our results of the lack of effect of sodium cromoglycate on histamine challenge are consistent with those of Pagelow.'2 He found no difference in the threshold of histamine bronchial reactivity with sodium cromoglycate or phentolamine. In contrast, Kerr et alt7 reported complete protection against histamine with both these agents. We have studied the effect of sodium cromoglycate in vitro on the alpha-receptor contraction of isolated human trachea induced by adrenaline in the presence of propranolol. In this system we are unable to show any inhibition by sodium cromoglycate of alpha-receptor contraction.13

Cholestasis of Pregnancy

“…37,38 Although maternal complications from ICP are rare, there are several adverse fetal effects including preterm labor, meconium aspiration, and fetal death. [37][38][39][40] Rencoret and Aste 37 reviewed 32 cases of jaundice in pregnancy (31 out of 32 cases with intrahepatic cholestasis) and reported two fetal deaths and a preterm labor rate of 33.3%. Reid and colleagues 38 analyzed complications in 56 pregnancies with ICP and reported an astonishingly high rate of adverse outcomes (ie, perinatal mortality rate 11%, meconium staining 27%, abnormal antepartum fetal heart rate pattern 14%, and preterm delivery rate 36%).…”

Increased PR Interval in Fetuses of Patients with Intrahepatic Cholestasis of Pregnancy

“…It has been observed that increasing the concentration of bile acids alters the sinoatrial node and induces bradycardia [8]. This mechanism might explain acute fetal death because an association with a chronic cause, such as placental insufficiency, has not been demonstrated [9,10]. …”

Intérêt de la variabilité à court terme dans la surveillance de la cholestase gravidique

“…A contrario, les anomalies rythmologiques ne sont pas si fréquentes (16 % seulement des foetus dans la série de cholestase de Reid et al [17]) ; par ailleurs, plusieurs cas de MFIU ont été rapportés en l'absence de signe de gravité (RCF non pathologiques, scores biophysique de Manning et biométries échographiques normaux, concentration des acides biliaires inférieure à 40 M), ce qui pose plusieurs questions :…”