Obstetric outcome of pregnancies complicated with intrahepatic cholestasis

Abstract

The incidence of intrahepatic cholestasis of pregnancy is estimated to be 0.5% of all deliveries, with great geographic variations. Clinical onset of this condition is represented by intolerable pruritus dominant on the palms and soles of the feet with the emphasizing of symptoms during the night. Regarding the risks for the fetus, the main complications are prematurity, intrauterine demise, meconium-stained amniotic fluid and a greater incidence of neonatal respiratory distress syndrome. Our retrospective study aimed to analyze the incidence of intrahepatic cholestasis of pregnancy for a period of five years in Bucharest Emergency University Hospital, fluctuations of the incidence depending on maternal age and parity, also, related neonatal risks. Secondly, we present a literature review regarding maternal and fetal follow-up and the possibilities for preventing the potential related complications. During the studied period, the incidence of intrahepatic cholestasis of pregnancy was 0.3%. Fetal status at birth was influenced by this condition, being reflected by an Apgar score lower than 8 in 34% of cases. Also, meconium stained fluid was associated in a higher proportion (14%) comparing to uncomplicated pregnancies in which fetal demise was showed not to be a direct consequence of intrahepatic cholestasis of pregnancy. The major purpose of management of these pregnancies consists in a rigorous fetal surveillance and early delivery guided by the comparison of the risk of fetal death and potential risks of prematurity. There is no ideal method for fetal surveillance in intrahepatic cholestasis of pregnancy yet.