Proposed use of shared decision making (SDM) to facilitate informed patient choice in the management of cholestasis of pregnancy (ICP)

Abstract

Despite a paucity of data that intrahepatic cholestasis of pregnancy (ICP) is a risk for unexplained term fetal demise, active management to achieve delivery between 36 0/7 and 37 0/7 weeks remains standard clinical practice. This practice continues despite conflicting evidence associating ICP with increased stillbirth risk, disregarding the simultaneous presence of voluminous data attesting to the perinatal and pediatric hazards associated with late preterm and early-term deliveries. This clinical risk correlation between possible antenatal death versus the potential long-term consequences for iatrogenic late preterm or early term infant born from an ICP affected pregnancy warrants inclusion of shared decision making to elicit the patient’s values and preferences during the ICP management option informed consent process.