Evaluation of the Gallbladder Dysmotility in the Pregnancy

INTRODUCTION: The hormonal changes that occur during the pregnancy increase the risk of developing gallstones. The impact of placental steroid hormones such as elevated estradiol (E2) and progesterone (PGN) continuously affect the biliary lipid storage and gallbladder activity in safe pregnant women. Gallbladder bile quantities of biliary cholesterol begin to increase from the first trimester to the third trimester of pregnancy, along with a steady increase in biliary sludge and gallstone occurrence. Ultrasound is a widely used method of imaging, and has the advantage of being safe for the pregnants. It is generally considered as the first line for gallbladder disease assessment. The study aimed to reveal whether there was a difference in motility marker values such as Fasting Volume (FV), Postprandial Volume (PPV), and Ejection Fraction (EF) between trimesters with the effect of changing steroid hormones. These parameters were also compared between groups of pregnant and non-pregnant people, considering gestation numbers.
METHODS: The patient group consists of 50 pregnant women who applied to the gynecology and obstetrics clinic at our hospital. 20 healthy non-pregnant women constituting the control group were also included in the present study. The age and parity of the cases were included in the study. The trimesters of the pregnancies were also recorded for the pregnant group. After the fasting on the day of the examination, gallbladder volumes of the patients were measured. After feeding for 45 minutes, gallbladder postprandial volume measurements were obtained. The gallbladder ejection fractions were calculated using these values (EF: [FV-PPV]×100/[FV]).
RESULTS: When the PPV mean values between the trimesters were observed, significant difference was not found between the 1st and 2nd trimesters (p>0.05) moreover significant difference was found between the 1st and 3rd trimesters and the 2nd and 3rd trimesters (p<0.001).
In the analysis made in terms of EF values, obtained from the pregnant group, the difference between the trimesters was found significant (p<0.05). In terms of EF mean values, any significant difference was not found between 1st and 2nd the trimesters and 2nd and 3rd trimester (p>0.05),but the difference between 1st and 3rd trimesters were found to be significant with the decrease of EF values in 3rd trimester (p<0.05). When comparing control group’s mean FV, PPV, and EF valuesto the pregnant women in the 3rd trimester consideringmean FV, TV and EF values, the difference was found to be statistically significant (p<0.001). However, a significant difference between the pregnant and control group was found when examining PPV values (p<0.05).
DISCUSSION AND CONCLUSION: Pregnancy is considered predisposing for gallbladder pathologies, because of the development of the bile stasis depending on insufficient bile excretion and changed bile content especially due to increased PGN and E2 hormone levels in the late period of pregnancy.
When the mean values obtained from the 3rd trimester pregnant women and the mean values of the control group were compared, the increase in FV and PPV and the decrease in EF were at statistically significant levels (p<0.001). These findings are expected results due to increases in PGN and E2 serum levels in the last trimester of pregnancy. In this study, there was a significant difference in PPV mean values of only nulliparous ones compared to the other groups (p<0.005), while no significant difference was found between the multiparity groups in terms of EF, FV, and PPV mean values.
When the pregnant group and control groups in the same parity were compared in terms of PPV mean values, the values of the pregnant group were significantly higher in the group with parity 1, compared to the values belonging to the control group. This result is an outcome of the negative effect of the first pregnancy forming bile stasis which is much higher than the following pregnancies.
It was concluded that the gallbladder dysfunction, which is held responsible for the emergence of gallbladder pathologies, the frequency of which increases in pregnancy, becomes more pronounced in the last trimester and in the first pregnancy the women are affected by hormonal changes more than following pregnancies.

Gebelikte Safra Kesesi Dismotilitesinin Değerlendirilmesi

GİRİŞ ve AMAÇ: Gebelik süreci sırasında artan steroid hormonların etkisi ile bilier lipid metabolizması ile safra kesesi fonksiyonunda önemli değişiklikler olur ve bu da litojenik safra oluşumunu kolaylaştırır.Çalışmanın amacı, farklı paritelerdeki ve farklı trimesterlerdeki sağlıklı gebeler ile gebe olmayan sağlıklı kontrol grubunun kese fonksiyonunu değerlendirerek, iki grup arasındaki farkı araştırmak ve artan gebelik sayısının safra kesesi motilitesine etkilerini ortaya koymaktı.
YÖNTEM ve GEREÇLER: Çalışmanın hasta grubu, sağlıklı ve gönüllü 50 gebe kadından oluşturulurken, kontrol grubu 20 sağlıklı gebe olmayan kadından oluşturuldu. Her iki gruptaki olguların yaş, gebelik haftası, gebelik sayısı kriterleri sorgulandı. Yöntem olarak 8 saatlik açlık sonrasında sonografik olarak olguların safra kesesi volümleri ölçüldü ve 80 gr. çikolata yedikten sonra 45. dakikada safra kesesi tokluk volümü ölçümü yapıldı. Elde edilen açlık volümü (AV), tokluk volümü(TV) ve kese ejeksiyon fraksiyonları(EF) hesaplandı. EF: (1-TV/AV) x 100.
BULGULAR: Gebe grubundan trimesterler arasında AV ve TV ortalamaları açısından incelendiğinde, 3. trimester ortalama değerleri diğer iki gruptan anlamlı düzeyde farklı olduğu saptanmıştır( p<0,001). EF ortalama değerleri açısından 1.ve 3. trimesterler arasındaki fark anlamlı bulunmuştur(p<0,05). Aynı paritedeki gebe ve kontrol grupları arasında AV, TV ve EF ortalama değerleri incelendiğinde sadece TV değerleri açısından, tek pariteli gebelerden elde edilenler ile diğer gruplar arasında anlamlı fark saptanmıştır.


TARTIŞMA ve SONUÇ: Gebelerde safra kesesi motilitesi ile ilgili yapılan çalışmalarda, genel olarak AV, TV ortalama değerlerinin gebeliğin geç dönemlerinde iki katına çıktığını bildirilmiştir. Bu çalışmada da benzer şekilde AV ortalama değerleri 3. trimesterde 1. trimesterin yaklaşık iki katına, TV ortalama değerleri üç katına ulaşmakta, EF ortalama değerleri ise 3.trimesterde 1.trimester ortalamasının yarısı kadar azalmaktadır. Bu sonuç, son trimesterde safra kesesi yetersiz ekskresyonunun belirginleştiğini desteklemektedir.
Sonuç:
Gebelikte sıklığı artan safra kesesi patolojilerinin ortaya çıkışından sorumlu tutulan kese disfonksiyonunun, son trimesterde oldukça belirginleştiği ve ilk gebeliğin, diğerlerine göre gebeliğe bağlı gelişen hormonal değişimden daha fazla etkilendiği sonucuna ulaşılmıştır.