Usefulness of fetal monitoring in intrahepatic cholestasis of pregnancy: a prospective study

Abstract

To study the role of fetal surveillance in intrahepatic cholestasis of pregnancy. A total of 69 women with obstetric cholestasis were included. Fetal surveillance began at 34 weeks or later at diagnosis and included daily maternal record of fetal movements, biophysical profile (i.e., non-stress test, amniotic fluid volume assessment using the four quadrant amniotic fluid index), and Doppler flow velocimetry. Fetal monitoring was done weekly before 36 weeks and biweekly after that. There were no abnormal non-stress test readings and all pregnancies had good biophysical profile. One hundred and sixty Doppler measurements [Systolic-Diastolic (S/D ratio) and Pourcelot index (PR)] were taken from 67 patients at scheduled intervals during the study period. Findings were compared to gestation matched reference values of Doppler flow velocities of umbilical artery of normal pregnant population. Fifty-six out of 160 PR indices and 33 out of 162 S/D ratio readings were above 2 SD and these results were found to be statistically significant. However, there was no significant correlation with the serum levels of alanine transaminase (r=-0.071) or with aspartate transaminase (r=0.058). Further, there was no correlation of Doppler with rates of preterm delivery or meconium-stained liquor. Doppler investigation of the umbilical artery might be of some value in recognition of the specific risk of fetal compromise in pregnancies complicated by intrahepatic cholestasis.