title: Intrahepatic cholestasis of pregnancy in women with a multiple pregnancy: an analysis of risks and pregnancy outcomes.
abstract: OBJECTIVE
  This study was conducted to assess the incidence and perinatal outcomes of multiple pregnancies complicated by intrahepatic cholestasis of pregnancy in an urban population.
  
  
  METHODS
  We performed a retrospective chart review of all multiple gestation deliveries at our institution between January 2004 and December 2005. Antepartum and delivery data were collected for all patients. Symptoms and treatment were also abstracted for patients in whom intrahepatic cholestasis was diagnosed. We used the Student two-tail t test and Fisher exact test to examine the differences between multiple gestation pregnancies with and without cholestasis of pregnancy.
  
  
  RESULTS
  Data were available for 263 multiple pregnancies. The incidence of cholestasis was 4.2% (11/263), with a mean onset at 29.4 weeks. There were no differences in mean gestational age at delivery, preterm delivery rate, meconium histiocytosis, incidence of preeclampsia, or incidence of postpartum hemorrhage between women with and those without cholestasis. There were no intrauterine fetal deaths in the cholestasis group.
  
  
  CONCLUSIONS
  Women with multiple gestations complicated by cholestasis of pregnancy do not have increased adverse perinatal outcomes. The absence of unexplained fetal demise may be a result of routine delivery before 40 weeks' gestation in multiple pregnancies.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON.
authors.forename: Andrea Y
authors.initials: AY
authors.lastname: Lausman
authors.affiliation: Department of Medicine, University of Toronto, Toronto ON.
authors.forename: Enas
authors.initials: E
authors.lastname: Al-Yaseen
authors.affiliation: Department of Medicine, University of Toronto, Toronto ON.
authors.forename: David
authors.initials: D
authors.lastname: Sam
authors.affiliation: Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON.
authors.forename: Romy
authors.initials: R
authors.lastname: Nitsch
authors.affiliation: Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON; Sunnybrook Health Sciences Centre, Toronto ON.
authors.forename: Jon F R
authors.initials: JFR
authors.lastname: Barrett
authors.affiliation: Department of Medicine, University of Toronto, Toronto ON.
authors.forename: Wee-Shian
authors.initials: WS
authors.lastname: Chan
mesh_terms: D000328:Adult; D002780:Cholestasis, Intrahepatic / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome; D011272:Pregnancy, Multiple; D012189:Retrospective Studies