Obstetrical and fetal outcomes of a new management strategy in patients with intra-hepatic cholestasis of pregnancy.
OBJECTIVE
To determine the incidence, obstetrical, and fetal complication rates of intrahepatic cholestasis of pregnancy (ICP) in patients managed expectantly to 40-weeks gestation.


METHODS
In a prospective cohort study conducted between February 2008 and January 2010, a total of 21,960 pregnant women in Qassim Region of Saudi Arabia were screened for ICP using specific criteria for diagnosis. The course of pregnancy was monitored to 40-weeks gestation or spontaneous onset of labor, whichever comes first. The measured outcomes were compared with a cross-matched group of healthy pregnant women. Continuous variables were analyzed with t test, while χ(2) test was used for comparing percentages.


RESULTS
The incidence of ICP was 0.35% (76/21,960). There was no significant difference between groups in gestational age at delivery, preterm labor, intrauterine fetal death, cesarean section, or respiratory distress syndrome. There was significantly higher intrapartum non-reassuring fetal heart rate patterns and meconium-stained amniotic fluid in ICP group (P < 0.01 and <0.0001, respectively).


CONCLUSIONS
The incidence of ICP in this region is low compared to worldwide range. Expectant management to 40-weeks gestation is associated with obstetrical and fetal outcomes comparable to normal pregnancy; however, intrapartum fetal asphyxia is more likely.
Al Shobaili
Hani A
HA
Department of Dermatology, Qassim University, Qassim, Saudi Arabia.
Hamed
Hossam O
HO
Al Robaee
Ahmad
A
Alzolibani
Abdullateef A
AA
Amin
Ahmad F
AF
Ahmad
Salah R
SR
D000293:Adolescent; D000328:Adult; D001238:Asphyxia Neonatorum / Q000453:epidemiology / Q000209:etiology; D016022:Case-Control Studies; D002780:Cholestasis, Intrahepatic / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D015331:Cohort Studies; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D005260:Female; D005316:Fetal Distress / Q000453:epidemiology / Q000209:etiology; D005323:Fetal Monitoring; D006801:Humans; D007231:Infant, Newborn; D008403:Mass Screening; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D011256:Pregnancy Outcome; D011446:Prospective Studies; D011536:Prurigo / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D012529:Saudi Arabia; D016216:Ultrasonography, Prenatal; D055815:Young Adult