PFM.41 Obstetric cholestasis: What is the future for its diagnosis and management

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Abstract

Aim

Obstetric cholestasis (OC) is an incompletely understood hepatobiliary disease that typically affects women in the third trimester of pregnancy. It is associated with increased morbidity and mortality for the fetus, including intrauterine fetal death (IUFD). However, the diagnosis is complex and requires exclusion of other pregnancy-related complications and the serological measurements used are non-specific. A sensitive and specific diagnostic test is needed to help simplify diagnosis. Mothers with obstetric cholestasis are managed by early induction of labour or caesarean section, to try and prevent IUFD. This practice lacks conclusive evidence of benefit; with evidence that expectant management has equivalent outcomes. 1,2 A prognostic test to identify high-risk fetuses is needed to prevent unnecessary inventions in potentially uncomplicated pregnancies. Method: Using Ovid SP Medline, Web of Science and the Cochrane library. The literature relevant to emerging diagnostic and prognostic tests was identified. The papers were synthesised to identify likely candidates for further research and incorporation into the diagnosis and management of obstetric cholestasis. Discussion: Potential candidates for providing a sensitive and specific test for obstetric cholestasis were identified. Autotaxin is a promising candidate that merits further study. 3 Potential prognostic tests were found that identify fetuses with a higher risk of complications. Serum bile acid level and cardiotocography have been shown to be ineffective screening tools. Umbilical artery Doppler pulsatility index and systolic/diastolic ratio correlate well with fetal outcome and could be used as a screening tool. 4 There remains a need to review current management protocols for OC informed by best evidence.

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