[Intrahepatic cholestasis of pregnancy: diagnosis and obstetric management]

Abstract

Aim: The aim of this study was to suggest a possible obstetric management of patients with intrahepatic cholestasis of pregnancy (ICP).

Methods: We performed a retrospective analysis enrolling 44 women with ICP deliveries at our Obstetrics and Gynaecology clinic of the University of Udine between January 2005 and July 2008. Data on patient age, body mass index, weight, gestational age, parity, symptoms, comorbidity, value of liver test, APGAR score and fetal weight were prospectively recorded in a computed database and clinical folder.

Results: The intensification of maternal and fetal surveillance in patients with ICP (liver function tests, ultrasound and cardiotocography), can significantly reduce perinatal mortality (no case of stillbirth in ours study) but, inevitably, increases the cesarean delivery rate (65.1%), the induction of labor rate (38.4%) and the preterm delivery rate (58.13 %, median gestational age 35 sg+/-1.46).

Conclusion: Obstetric management of ICP consist of weighing the risk of premature delivery against the risk of sudden death in utero. To date, no ideal method of fetal surveillance has been determined for ICP; the intrauterine deaths are thought to occur suddenly and fetal cardiac monitoring cannot forecast an acute event. Nevertheless, we think that a management strategy, inclusive of induction of labor at 37 weeks, can reduces the risk of fetal death. In most severe cases, no responsive to ursodeoxycholic acid and S-adenosylmethionine treatment, delivery has been initiated even before the 37 weeks, as soon as lung maturity has been established.