Outcome after implementation of a modern management strategy for intrahepatic cholestasis of pregnancy

Abstract

Objective: The aim of this study was to determine whether the institution of a modern management strategy affected pregnancy outcomes for intrahepatic cholestasis of pregnancy (ICP).

Methods: We performed a retrospective cohort study of women diagnosed with ICP at one hospital from 2005 to 2013. A new management protocol for ICP was instituted in 2009 for women with total bile acids >40 μmol/L at <36 weeks. This strategy included inpatient admission, continuous fetal heart rate monitoring, with delivery between 36 and 37 weeks. We compared maternal and neonatal outcomes prior and subsequent to the institution of this protocol.

Results: We identified 186 singleton gestations with bile acids >40 μmol/L and diagnosis <36 weeks. Patient demographics were similar between the groups, with the exception of greater maternal age and gestational diabetes in the newer cohort. The newer cohort demonstrated a significant reduction in the incidence of stillbirth 0% versus 3.4%, p= 0.035). There was no difference in the age at delivery, cesarean delivery rates or NICU admissions.

Conclusion: Application of our management strategy for ICP reduced the stillbirth rate without adversely affecting other maternal and neonatal outcomes.

Keywords: Cholestasis of pregnancy; obstetric protocol; stillbirth.