Pregnancy outcomes during an era of aggressive management for intrahepatic cholestasis of pregnancy.
Our objective was to examine whether delivery at 37 weeks of gestation alters adverse pregnancy outcomes in Latina patients with intrahepatic cholestasis of pregnancy (ICP). We conducted a retrospective chart review of Latina patients who delivered at our institution coded with ICP between 2000 and 2007. During this time period it was our practice to offer delivery to patients with ICP at 37 weeks of gestation. Subjects were classified into three groups according to total bile acid (TBA) concentration: < 20 micromol/L (mild ICP), > or = 20 micromol/L and < 40 micromol/L (moderate ICP), and > or = 40 micromol/L (severe ICP). Meconium passage was observed in no births in patients with mild IC, but was found in 18% of deliveries with moderate/severe ICP. The risk of meconium passage increased linearly, with a 19.7% increased risk for each 10 mumol/L increase in TBA concentration ( P = 0.001). There was no association with higher TBA concentration and other adverse outcomes. There was no difference in adverse outcomes between moderate and severe ICP. We concluded that in our Latina population with ICP, an association existed between meconium passage and moderate/severe ICP. Delivering at 37 weeks was associated with a low risk of adverse outcomes due to ICP among all patients, including those with higher TBA concentrations.
Department of Obstetrics and Gynecology, Los Angeles County-University of Southern California Medical Center, Los Angeles, California, USA.
Richard H
RH
Lee
Kay May
KM
Kwok
Sue
S
Ingles
Melissa L
ML
Wilson
Patrick
P
Mullin
Marc
M
Incerpi
Bhuvan
B
Pathak
T Murphy
TM
Goodwin
D000328:Adult; D001647:Bile Acids and Salts / Q000097:blood; D002780:Cholestasis, Intrahepatic / Q000097:blood / Q000208:ethnology* / Q000628:therapy; D003430:Cross-Sectional Studies; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D015141:Los Angeles / Q000453:epidemiology; D008470:Meconium; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000208:ethnology* / Q000628:therapy; D011256:Pregnancy Outcome / Q000208:ethnology*; D012189:Retrospective Studies
D001647:Bile Acids and Salts