title: Sudden fetal death in intrahepatic cholestasis of pregnancy.
abstract: BACKGROUND
  Intrahepatic cholestasis of pregnancy is associated with an increased risk of fetal death. The mechanism of death is unknown.
  
  
  METHODS
  The first case involved a young primipara with pruritus and a bile acid concentration of 79 mumol/dL. While undergoing fetal heart rate monitoring, the fetus had a prolonged deceleration resulting in intrauterine death. The second case involved a young multipara with cholestasis who received ursodeoxycholic acid. Her bile acid concentration improved to13 micromol/dL. At 34 weeks of gestation, she had uterine contractions with prolonged decelerations resulting in delivery of her fetus with Apgar scores of 0, 0, and 5 at 1, 5, and 10 minutes, respectively.
  
  
  CONCLUSIONS
  Fetal death from intrahepatic cholestasis of pregnancy can be abrupt and not reliably predicted by the characteristics of the fetal heart rate tracing.
authors.affiliation: From the University of Southern California, Los Angeles, California.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Lee
authors.forename: Marc H
authors.initials: MH
authors.lastname: Incerpi
authors.forename: David A
authors.initials: DA
authors.lastname: Miller
authors.forename: Bhuvan
authors.initials: B
authors.lastname: Pathak
authors.forename: T Murphy
authors.initials: TM
authors.lastname: Goodwin
mesh_terms: D000328:Adult; D002780:Cholestasis, Intrahepatic / Q000150:complications*; D005260:Female; D005313:Fetal Death; D006340:Heart Rate, Fetal; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications; D011263:Pregnancy Trimester, Third; D047928:Premature Birth; D055815:Young Adult