title: Risks of emergency cesarean section and fetal asphyxia after induction of labor in intrahepatic cholestasis of pregnancy: a hospital-based retrospective cohort study.
abstract: OBJECTIVE
  Intrahepatic cholestasis of pregnancy (ICP) is the most common pregnancy liver-specific disease. Induction of labor in gestational weeks 37-39 is commonly performed with the perspective to avoid the complication of stillbirth. We aimed to study whether this practice increases the risks of emergency cesarean section (CS) and fetal asphyxia.
  
  
  METHODS
  We assessed the risk of emergency CS and fetal asphyxia in ICP among women with spontaneous and induced onset of labor in comparison to women without ICP. We performed a hospital based retrospective cohort study with 25,870 singleton pregnancies, 333 with ICP (1.3%), of which 231 gave birth in weeks 37-39. Obstetric outcome was assessed through linkage of the Swedish Medical Birth Registry and a local obstetrical database based on the patient's medical files.
  
  
  METHODS
  Risk for emergency CS; fetal asphyxia and postpartum hemorrhage.
  
  
  RESULTS
  The risk of emergency CS in ICP with spontaneous onset of labor (12.5%) did not differ from non ICP women with spontaneous onset of labor (9.3%; aOR, 1.33; 95% CI 0.60-2.96). When labor was induced, risk of emergency CS was significantly lower among women with ICP than among without ICP (aOR, 0.47; 95% CI 0.26-0.86). Exclusion of women with preeclampsia, gestational hypertension or diabetes mellitus did not alter the result. The risk for fetal asphyxia was not significantly associated with ICP status.
  
  
  CONCLUSIONS
  Induction of labor in women with ICP gestational weeks 37-39 did not increase the risks of emergency CS or fetal asphyxia.
authors: Department of Obstetrics and Gynecology, Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden. Elisabeth@gynocular.com
authors: Elisabeth A
authors: EA
authors: Wikström Shemer
authors: Malin
authors: M
authors: Thorsell
authors: Hanns-Ulrich
authors: HU
authors: Marschall
authors: Magnus
authors: M
authors: Kaijser
mesh_terms: D000328:Adult; D001238:Asphyxia Neonatorum / Q000209:etiology*; D016022:Case-Control Studies; D002585:Cesarean Section; D002780:Cholestasis, Intrahepatic / Q000150:complications*; D015331:Cohort Studies; D005260:Female; D005311:Fetal Hypoxia / Q000209:etiology*; D006761:Hospitals; D006801:Humans; D007231:Infant, Newborn; D007751:Labor, Induced / Q000009:adverse effects*; D007744:Obstetric Labor Complications; D006473:Postpartum Hemorrhage / Q000209:etiology*; D011247:Pregnancy; D011248:Pregnancy Complications; D012189:Retrospective Studies; D012307:Risk Factors; D013548:Sweden