Ursodeoxycholic acid in the treatment of cholestasis of pregnancy: a randomized, double-blind study controlled with placebo.

BACKGROUND/AIMS: Intense pruritus and the risk of stillbirths and premature deliveries justify the search for an effective pharmacologic treatment of intrahepatic cholestasis of pregnancy. This study was designed to test the efficacy of ursodeoxycholic acid in maternal pruritus, the biochemical abnormalities and the outcome of pregnancy, in patients with intrahepatic cholestasis of pregnancy of early onset. METHODS: Pregnant patients hospitalized in a secondary case-referral center with intense pruritus and abnormal serum levels of bile salts and aminotransferases, detected before week 33 of pregnancy, were randomly assigned to receive ursodeoxycholic acid, 1 g per day orally, or an identical placebo, until delivery, in a double-blind study. A 3-week trial period was chosen to compare drug and placebo effects. The follow-up was extended for 3 months after delivery. RESULTS: Twenty-four patients entered the trial; eight had deliveries before 2 weeks of treatment and one dropped out. The study was then completed in 15 patients: eight received ursodeoxycholic acid and seven placebo. No adverse effects were detected in the mothers or in their babies. After 3 weeks of treatment, patients receiving ursodeoxycholic acid (mean daily dose 16 mg/kg body weight) had a significant improvement in pruritus (p<0.02), in serum bilirubin (0.36+/-0.19 mg/dl (mean+/-SD) versus 0.95+/-0.48 in patients receiving placebo, p<0.01), in aspartate aminotransferase (52+/-42 IU/l vs 98+/-44, p<0.05) and in alanine aminotransferase (54+/-50 IU/l vs 229+/-154, p<0.01); serum total bile salts also tended to be lower in patients receiving ursodeoxycholic acid (26.3+/-33.7 micromol/l vs 55.0+/-44.8, p N.S.). Deliveries occurred at or near term in all mothers who received ursodeoxycholic acid (mean week of pregnancy: 38), while they occurred before week 36 of pregnancy in five patients who received placebo, including one stillbirth. All babies born alive had birth weights adequate for gestational age and they were thriving normally 3 months after delivery. CONCLUSIONS: Ursodeoxycholic acid is effective and safe in patients with intrahepatic cholestasis of pregnancy of early onset, attenuating pruritus and correcting some biochemical abnormalities in the mothers. Relevant aspects of fetal outcome were also improved in patients receiving ursodeoxycholic acid compared to placebo.

Tromboflebitis pelviana. Tratamiento medico. Presentacion de tres casos. / Pelvic thrombophlebitis. Medical treatment.Presentation of three cases

Se revisa la bibliografia de tromboflebitis pelviana incluyendo un pequeno bosquejo historico. frecuencia, cuadro clinico, diagnostico y tratamiento. Se revisan y analizan tres casos clinicos, llamando la atencion sobre la evolucion favorable cuando el tratamiento con heparina se hace precozmente. En la tercera paciente el diagnostico de tromboflebitis pelviana fue demasiado tardio; no respondio al tratamiento con hepariana y no se realizo tratamiento quirurgico por considerar que la paciente estaba demasiado comprometida, y fallece al mes de ingresada

Escurrimiento de liquido amniotico consecutivo a amniocentesis. / Vaginal leakage of amniotic fluid as a consequence of amniocentesis

1. Se decribe el caso clinico de una paciente primigesta, con embarazo de 38 semanas, que presenta escurrimiento de liquido amniotico consecutivo a amniocentesis, (ELA-CA). 2. En el estudio del liquido amniotico se encuentra virus Herpes II, y se comenta este hallazgo.3. Se plantea metodo para evaluar sindrome de infeccion de liquido amniotico, corioamnionitis e infeccion fetal. 4. Se revisa la literatura, y se senala frecuencia y evolucion de esta complicacion