Assessment of the fetal thymic-thoracic ratio in pregnant women with intrahepatic cholestasis: a prospective case-control study

Zahid Agaoglu; Atakan Tanacan; Burcu Bozkurt Ozdal; Ezgi Basaran; Hakkı Serbetci; Merve Ozturk Agaoglu; Gulcan Okutucu; Ozgur Kara; Dilek Sahin

doi:10.1515/jpm-2024-0191

Article

Assessment of the fetal thymic-thoracic ratio in pregnant women with intrahepatic cholestasis: a prospective case-control study

Zahid Agaoglu , Atakan Tanacan , Burcu Bozkurt Ozdal , Ezgi Basaran , Hakkı Serbetci , Merve Ozturk Agaoglu , Gulcan Okutucu , Ozgur Kara and Dilek Sahin

Published/Copyright: June 19, 2024

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From the journal Journal of Perinatal Medicine Volume 52 Issue 7

Abstract

Objectives

To examine the fetal thymic-thoracic ratio (TTR) in intrahepatic cholestasis of pregnancy (ICP).

Methods

This prospective case-control study was conducted in a single tertiary center. The sample consisted of 86 pregnant women at 28–37 weeks of gestation, including 43 women with ICP and 43 healthy controls. TTR was calculated for each patient using the anterior-posterior measurements of the thymus and intrathoracic mediastinal measurements.

Results

The median TTR value was found to be smaller in the ICP group compared to the control group (0.32 vs. 0.36, p<0.001). The ICP group had a greater rate of admission to the neonatal intensive care unit (NICU) (p<0.001). Univariate regression analysis revealed that lower TTR values increased the possibility of NICU admission six times (95 % confidence interval: 0.26–0.39, p=0.01). A statistically significant negative correlation was detected between TTR and the NICU requirement (r: −0.435, p=0.004). As a result of the receiver operating characteristic analysis, in predicting NICU admission, the optimal cut-off value of TTR was determined to be 0.31 with 78 % sensitivity and 67 % specificity (area under the curve=0.819; p<0.001).

Conclusions

We determined that the fetal TTR may be affected by the inflammatory process caused by the maternal-fetal immune system and increased serum bile acid levels in fetal organs in the presence of ICP. We consider that TTR can be used to predict adverse pregnancy outcomes in patients with ICP.

Keywords: immune system; inflammation; intrahepatic cholestasis of pregnancy; thymic-thoracic ratio; outcome

Corresponding Author: Zahid Agaoglu, MD, Maternal Fetal Specialist, Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Universiteler Mahallesi Bilkent Cad. No: 1, Cankaya 06800, Ankara, Türkiye, E-mail: zahidagaoglu04@hotmail.com

Research ethics: Approval for the study was obtained from the Ethics Committee of the hospital (number: E2-23-4051). The principles of the Declaration of Helsinki were followed at every stage of the study.
Informed consent: Informed consent was provided by each patient included in the study.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission. ZA: Conceptualization, Methodology, Drafting the article, Supervision, Visualization. AT: Conceptualization, Investigation, Drafting the article, Methodology, Visualization. BBO: Investigation, Data curation, Drafting the article, Visualization, Formal Analysis. EB: Data curation, Visualization, Writing – original draft. HS: Data curation, Formal Analysis, Drafting the article. MOA: Investigation, Data curation, Drafting the article, Formal Analysis. GO: Data curation, Visualization, Drafting the article. OK: Analysis and interpretation of data, Validation, Visualization, Writing – review & editing. DS: Analysis and interpretation of data, Validation, Visualization, Writing – review & editing.
Competing interests: The authors state no conflicts of interest.
Research funding: None declared.
Data availability: The raw data can be obtained on request from the corresponding author.

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Received: 2024-04-26

Accepted: 2024-05-27

Published Online: 2024-06-19

Published in Print: 2024-09-25

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Articles in the same Issue

https://doi.org/10.1515/jpm-2024-0191

Keywords for this article

immune system; inflammation; intrahepatic cholestasis of pregnancy; thymic-thoracic ratio; outcome