Obstetric cholestasis: outcome with active management

• Published in: European journal of obstetrics & gynecology and reproductive biology 2002-01, Vol.100 (2), p.167-170
• Main Authors: Roncaglia, Nadia, Arreghini, Alessandra, Locatelli, Anna, Bellini, Primula, Andreotti, Camilla, Ghidini, Alessandro
• Format: Article
• Language: English
• Subjects: Adult; Alanine Transaminase - blood; Amniotic Fluid; Aspartate Aminotransferases - blood; Bile Acids and Salts - blood; Bilirubin - blood; Biological and medical sciences; Cholagogues and Choleretics - therapeutic use; Cholestasis, Intrahepatic - complications; Cholestasis, Intrahepatic - diagnosis; Cholestasis, Intrahepatic - drug therapy; Cholestyramine Resin - therapeutic use; Diseases of mother, fetus and pregnancy; Female; Fetal Death - etiology; Fetal Monitoring; Fetoscopy; Gestational Age; Gynecology. Andrology. Obstetrics; Humans; Labor, Induced; Meconium; Medical sciences; Middle Aged; Obstetric cholestasis; Odds Ratio; Perinatal mortality; Pregnancy; Pregnancy Complications - drug therapy; Pregnancy. Fetus. Placenta; S-Adenosylmethionine - therapeutic use; Ursodeoxycholic Acid - therapeutic use
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/S0301-2115(01)00463-8

Objective: Conservative management of intrahepatic obstetric cholestasis is associated with a high stillbirth rate despite monitoring of fetal well-being with non-stress test and amniotic fluid volume assessment. Most cases of stillbirth are associated with meconium passage. We prospectively evaluated the effect of a management protocol inclusive of surveillance for presence of meconium and induction of labor at 37 weeks. Study Design: Between January 1989 and December 1997, all women with obstetric cholestasis underwent transcervical amnioscopy after 36 weeks for assessment of amniotic fluid color, in addition to standard monitoring of fetal well-being (semi-weekly non-stress test and amniotic fluid volume determinations). Amniocentesis for fetal lung maturity and amniotic fluid color assessment was performed before 36 weeks in severe cases. Labor was induced at 37 weeks or earlier in the presence of non-reassuring fetal testing, meconium, or severe maternal symptoms unresponsive to therapy with mature fetal lungs. The obstetric outcome of the group with cholestasis was compared with that of the general obstetric population at our Institution during the study period. The rate of fetal death in the study group was compared with that of series published within the last 20 years, which used expectancy and conventional monitoring of fetal well-being. Statistical analysis utilized Fisher’s exact test, Chi-square, and Student’s t-test with P value