title: Obstetric cholestasis: outcome with active management.
abstract: OBJECTIVE
  To study the nature and clinical outcome of pregnancies with obstetric cholestasis on active management and to correlate perinatal outcome to gestational age at delivery.
  
  
  METHODS
  This prospective randomized study included 69 women with obstetric cholestasis. Fetal surveillance began at 34 weeks or later at diagnosis and included daily maternal record of fetal movements, and biophysical profile (i.e. non stress test, the four quadrant amniotic fluid index). Fetal monitoring was conducted weekly before 36 weeks and biweekly after that. Randomization into two groups was done where one group was planned for delivery at 37 weeks whereas in the other group, pregnancy was carried to 38 weeks under surveillance. The primary outcome variable was correlation of fetal and neonatal complication rates to gestational age at delivery.
  
  
  RESULTS
  There were no stillbirths in the study. No episode of fetal asphyxia or bradycardia was observed. The overall rate of meconium passage was 7.46% (5/67). However, there was no case of meconium aspiration syndrome. Women delivering at or after 38 weeks had a lower incidence of cesarean section (17.85% vs 25.8%), neonatal nursery admission (17.85% vs 22.5%), and neonatal jaundice (17.85% vs 19.35%) compared to those delivering at 37 weeks. The differences between the two groups were, however, not found to be statistically significant.
  
  
  CONCLUSIONS
  The current study demonstrates that with active intervention, pregnancies with obstetric cholestasis can be carried to a later gestation under surveillance.
authors.affiliation: Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Reenu
authors.initials: R
authors.lastname: Jain
authors.forename: Vanita
authors.initials: V
authors.lastname: Suri
authors.forename: Seema
authors.initials: S
authors.lastname: Chopra
authors.forename: Yogesh K
authors.initials: YK
authors.lastname: Chawla
authors.forename: Krishan Kumar
authors.initials: KK
authors.lastname: Kohli
mesh_terms: D000328:Adult; D002585:Cesarean Section; D002780:Cholestasis, Intrahepatic / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D008470:Meconium; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology / Q000628:therapy*; D011256:Pregnancy Outcome; D012306:Risk