Fetal death in a patient with intrahepatic cholestasis of pregnancy.
BACKGROUND
Treatment with ursodeoxycholic acid in intrahepatic cholestasis of pregnancy reduces concentration of transaminases and bile acids in maternal serum, and is thought to reduce fetal death. We report a case of fetal death in a patient with intrahepatic cholestasis of pregnancy who had responded well to ursodeoxycholic acid, demonstrated by a low bile level.


METHODS
A young nulliparous woman presented with intrahepatic cholestasis of pregnancy at 28 weeks of gestation. Transaminases and bile acids decreased after ursodeoxycholic acid administration. The patient was discharged from the hospital until delivery and received biochemical markers and conventional fetal monitoring twice weekly. Due to low bile acid values (< 13 UI/L) and unfavorable cervix, the patient was followed up expectantly. Fetal death occurred at 39 weeks and 3 days, although cardiotocograph testing results were normal the day before.


CONCLUSIONS
When lung maturity is achieved for patients with intrahepatic cholestasis of pregnancy, delivery should be considered.
Sentilhes
Loïc
L
Department of Obstetrics and Gynecology, Rouen University Hospital-Charles Nicolle, Rouen, France. loicsentilhes@hotmail.com
Verspyck
Eric
E
Pia
Patrick
P
Marpeau
Loïc
L
D002756:Cholagogues and Choleretics / Q000627:therapeutic use; D002780:Cholestasis, Intrahepatic / Q000188:drug therapy; D005260:Female; D005313:Fetal Death; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
D002756:Cholagogues and Choleretics; D014580:Ursodeoxycholic Acid