title: Early induction of labor in high-risk intrahepatic cholestasis of pregnancy: what are the costs?
abstract: Induction of labor among pregnant women with high levels of total bile acid (TBA) is common among clinicians. We examined, if women with intrahepatic cholestasis of pregnancy (ICP) and TBA ≥ 40 μmol/l have a higher risk of maternal-fetal complications, when labor is induced at 37 weeks of gestation, compared with induction of labor at term in women with low-risk ICP.
  
  
  
  Retrospective cohort study of 16,185 women delivering at Roskilde University Hospital in the period 2006-2011. Women with high-risk ICP (TBA ≥ 40 μmol/l) had labor induced at 37 weeks of gestation; women with low-risk ICP (TBA < 40 μmol/l) at term.
  
  
  
  Mode of delivery, duration of induction procedures, highest level of TBA and alanine aminotransferase (ALT) and for the neonates: Apgar scores at 5 min, umbilical cord pHs and SBEs, NICU admissions and birthweights.
  
  
  
  The incidences of ICP was 1.2 % (95 % CI 1.05-1.39 %) altogether and for high-risk ICP 0.4 % (95 % CI 0.27-0.46 %). No difference was found in mode of delivery, length of induction of labor nor in neonatal outcomes, except for an expected difference in birthweight. In high-risk ICP, ALT was not raised in 10.3 % (95 % CI 2.5-18.2 %).
  
  
  
  Early induction of labor at 37 weeks of gestation seems justified in high-risk ICP, as, except for abbreviating gestational age by 9 days with 296 g smaller babies, induction of labor was not followed by detectable maternal-fetal disadvantages and is favored by an expected major reduction in ICP stillbirth risk.
authors.affiliation: Department of Obstetrics and Gynecology, Roskilde University Hospital, Koegevej 7-13, 4000, Roskilde, Denmark. katrine.friberg@gmail.com.
authors.forename: Anne Katrine
authors.initials: AK
authors.lastname: Friberg
authors.affiliation: Department of Obstetrics and Gynecology, Roskilde University Hospital, Koegevej 7-13, 4000, Roskilde, Denmark.
authors.forename: Vera
authors.initials: V
authors.lastname: Zingmark
authors.affiliation: Department of Obstetrics and Gynecology, Roskilde University Hospital, Koegevej 7-13, 4000, Roskilde, Denmark.
authors.forename: Jens
authors.initials: J
authors.lastname: Lyndrup
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000378:metabolism; D001034:Apgar Score; D001647:Bile Acids and Salts / Q000378:metabolism*; D001724:Birth Weight; D002780:Cholestasis, Intrahepatic / Q000503:physiopathology*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007751:Labor, Induced; D007743:Labor, Obstetric; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology*; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D050497:Stillbirth / Q000453:epidemiology
chemical_list: D001647:Bile Acids and Salts; D000410:Alanine Transaminase
keywords: Cesarean section; Induction of labor; Intrahepatic cholestasis of pregnancy; Total bile acid concentration