Intrahepatic cholestasis of pregnancy: Perinatal outcome associated with expectant management,☆☆,

Presented at the Sixteenth Annual Meeting of the Society of Perinatal Obstetricians, Kamuela, Hawaii, February 4-10, 1996.
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Abstract

OBJECTIVE: Our goal was to compare the pregnancy outcomes of patients with intrahepatic cholestasis of pregnancy managed expectantly with antepartum testing with those of other patients who were followed up with a similar testing scheme. STUDY DESIGN: Cases of intrahepatic cholestasis of pregnancy monitored with antepartum testing at our institution over a 7-year period were reviewed. Their pregnancy outcomes were compared with those of control patients followed up with the same testing scheme for a history of stillbirth. Both groups had at least weekly nonstress tests and amniotic fluid assessment until spontaneous labor or delivery for standard obstetric indications. RESULTS: Seventy-nine patients were analyzed in each group. The two groups did not differ with respect to the mean gestational age at delivery (38.5 vs 38.8 weeks), birth weight (3216 vs 3277 gm) or incidence of preterm delivery (14% vs 7.6%). Abnormal antepartum testing prompting delivery was more common in the control group (25% vs 7.6%, p < 0.05). The risk of meconium passage was higher in the cholestasis group (44.3% vs 7.6%, p < 0.05). Two antepartum fetal deaths occurred in the cholestasis group at 36 to 37 weeks' gestation within 5 days of normal results of antepartum testing. Thick meconium and appropriate birth weight were noted in both infants. No gross anomalies were found in either infant. CONCLUSION: Intrahepatic cholestasis of pregnancy is associated with adverse perinatal outcome not predicted by conventional fetal surveillance. (Am J Obstet Gynecol 1996;175:957-60.)

Section snippets

MATERIAL AND METHODS

We reviewed the medical records of all patients who underwent antepartum testing for intrahepatic cholestasis of pregnancy at Los Angeles County/University of Southern California Medical Center over a 7-year period (1988 through 1995). The diagnosis of intrahepatic cholestasis of pregnancy was based on the presence of generalized pruritus in the absence of other skin or medical conditions that could produce pruritus. When suspected, viral hepatitis and obstructive gallstones were excluded with

RESULTS

During the study period 79 patients underwent antepartum testing for intrahepatic cholestasis of pregnancy, and management was undertaken as described. Seventy-nine consecutive patients who underwent antepartum testing for a history of unexplained fetal death were used as a control group. There was no significant difference between the two groups in maternal age; however, the control patients had higher parity because none was primigravid. Labor induction was more common in control patients

COMMENT

The role of antepartum testing in the management of pregnancies complicated by intrahepatic cholestasis of pregnancy is unclear. We used antepartum testing in the management of such patients, but it did not successfully predict fetal compromise, as shown by two intrauterine fetal deaths within 5 days of a normal nonstress test result. The two fetal deaths observed in the cholestasis group correspond to a perinatal mortality rate of 25 per 1000. Because of the limited number of cholestasis

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From the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California School of Medicine.

☆☆

Reprint requests: Owaidah M. Alsulyman, MD, Room 5K40, Women's and Children's Hospital, 1240 N. Mission Road, Los Angeles, CA 90033.

0002-9378/96 $5.00 + 0 6/6/75294

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