Obstetric cholestasis – an audit on its management and complications in Leeds

Abstract

Background The complications associated with obstetric cholestasis (OC) are unclear. This means that the appropriate management of OC is also unclear and often not evidence based. Aims and objectives To audit current practices in the management OC across Leeds, adherence to current guidelines and complications in the OC population. Methods The notes of 100 women who were prescribed ursodeoxycholic acid (UDCA) from May 2009 to December 2010 were obtained. 60 of the patients' notes were retrieved and retrospectively audited. Results 95% of patients were monitored by fetal ultrasound scans (USS) and 47% by CTG antenatally. Labour was induced in 72% of patients. 22% of deliveries were preterm. In 30% of cases there were signs of fetal distress during labour but there were no cases of fetal death. There was only one significant case of post-partum haemorrhage. A relationship between bile acid levels, bilirubin levels and complications in OC is possible but the figures are not significant. Conclusion There was an increased incidence of fetal distress and preterm delivery compared to national statistics but this could be attributed to the increased rate of labour induction and known co-morbidities in these patients. Most women were monitored fortnightly by USS; this was not evidence based, did not affect management decisions and could be a waste of resources. The appropriate treatment of OC needs to be clarified as currently the benefit of management such as inducing labour early are unclear and may cause further complications such as fetal distress during labour.