Outcomes in Intrahepatic Cholestasis of Pregnancy Managed via a Multifaceted Protocol [31D]

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Abstract

INTRODUCTION:

Intrahepatic cholestasis of pregnancy (ICP) is characterized by pruritus, elevated bile acids, usually presents in the second or third trimesters, and is associated with Intra-uterine fetal demise (IUFD). Perinatal morbidity is the lowest at 35 weeks and rises after 36 weeks, with a stillbirth rate of 1.2% after 37 weeks. The original studies that prompted early deliveries, there were 4 IUFD among 331 cases. Subsequent meta analyses refuted that. The goal of our study was to identify factors correlated with a reassuring prognosis and permit expectant management beyond 37 weeks.

METHODS:

A retrospective chart review of women admitted to NBIMC for ICP between January 1st 2013 and December 31st 2016. CPT codes were used to identify cases of ICP. 52 charts met inclusion criteria and a statistical analysis was performed.

RESULTS:

In our series no stillbirth occurred. No single factor was identified that correlated with a reassuring outcome, therefore we conclude that a multifaceted approach with active maternal fetal surveillance and use of ursodeoxycholic acid likely contributed to a lower stillbirth rate, however, it is possible our small data set caused a Type 2 error.

CONCLUSION:

As no RCTs are available to guide management, further case series, meta analyses, or a registry could be the solution. We present our multifaceted approach to management that includes serial bile acids, liver function tests, treatment with ursodeoxycholic acid, monitoring of symptoms, and intensive fetal surveillance, which may allow pregnancy to proceed to 38 weeks or beyond.

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