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Clin Invest Ginecol Obstet 2001;28:344-52 - DOI: 10.1016/S0210-573X(01)77120-1
Colestasis intrahepática del embarazo. Tratamiento con ácido ursodesoxicólico
L.C. Tejerizo-López, M.M. Sánchez-Sánchez, R.M. García-Robles, J. Moro, A.I. Teijelo, F. Jiménez-Vicente, J.A. Pérez-Escanilla, J.M. Benavente, F. Corredera, A. Tejerizo-García
Servicios de Obstetricia y Ginecología, Medicina Interna. Hospital Virgen de la Vega. Salamanca. España
Aceptado 10 abril 2000
Resumen

El ácido ursodesoxicólico, empleado en el tratamiento de colestasis intrahepática que se da en la cirrosis biliar primaria, colangitis esclerosante primaria, y hepatitis crónica, no tiene aprobación en el mercado para su prescripción durante el embarazo debido a lafalta de información.

En dos casos de colestasis gravídica, nosotros administramos ácido ursodesoxicólico oral 1 g al día a apartir de la 34 semana de amenorrea hasta el parto. En ambos casos, en 3 días de tratamiento hubo regresión completa del prurito y descendieron los niveles plasmáticos del ácido biliar y de las transaminasas. Los niños, nacidos entre las 37 y 38 semanas de amenorrea, no presentaron ningún problema.

Cincuenta y un casos de colestasis gravídica tratados con ursodesoxicólico (0,4 a 1 g por día) han sidodescritos en la bibliografía 18 casos pertenecientes a2 estudios randomizados. En 49 casos el prurito desapareció generalmente a los 3 días de establecer el tratamiento, y los niveles de ácido biliar en plasma y transaminasas descendieron en una semana. Sólo 2 pacientes experimentaron prurito persistente a pesar de la mejora en el aspecto biológico. No se han descrito efectos adversos.

El ácido ursodexoxicólico parece ser un tratamiento eficaz para la colestasis gravídica. Es necesaria una observación a largo plazo de los fetos expuestos en el útero a este tratamiento para valorar su seguridad.

Summary

Ursodeoxycholic acid, used in the treatment of in-trahepatic cholestasis present in the chronic liver diseases such as, primary biliary cirrhosis, primary sclerosing cholangitis or chronic hepatitis, is contra-indicated in pregnant women as there are no studies of its use in pregnancy.

In 2 cases of gravid cholestasis we administered a dose of 1mg/day from the 34th week of amenorrhoea until delivery. In both cases, pruritus regressed completely after 3 days of treatment and plasma levels of biliary acid and transaminases began to decrease. Both infants, born between the 37th and 38th weeks, were normal.

In the literature we found 51 cases of gravid cho-lestasis treated with Ursodeoxycholic acid in doses varying from 400mg to 1g/day. Of these 18 cases were in 2 randomised studies. In 49 cases pruritus had generally disappeared 3 days after the start of treatment and plasma levels of biliary acids and transami-nases decreased in one week. Only two patients experienced persistent pruritus, although the biological criteria of cholestasis had decreased. No foetal teratogenicity or toxicity was observed.

Ursodeoxycholic acid seems to be an efficient treatment of gravid cholestasis. Long term observation of children exposed to this treatment in utero are required to confirm its apparent foetal safety.

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