Operative delivery rates following induction of labour for obstetric cholestasis

Webster, J. R.; Chappell, LC; Cheng, F.; Breeze, Andrew C. G.; Lucas, Nuala; Plaat, Felice van der; Williamson, C.

doi:10.1258/om.2011.100080

Cited by 3 publications

(3 citation statements)

References 4 publications

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“…A case–control study (64 cases) 50 and case‐cohort study (348 cases) 51 both showed no increased risk of postpartum haemorrhage in women with ICP. Standard care using national guidance for the third stage of birth should be followed 33 .…”

Section: How Should Women Be Advised On Timing and Mode Of Birth?mentioning

confidence: 93%

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Intrahepatic cholestasis of pregnancy

Girling¹,

Knight²,

Chappell³

2022

BJOG

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The diagnosis of intrahepatic cholestasis of pregnancy (ICP) should be considered in pregnant women who have itching in skin of normal appearance and raised peak random total bile acid concentration of 19 micromol/L or more. [Grade D] • Additional laboratory and/or imaging investigations are not recommended unless itch is associated with atypical clinical symptoms, the presence of relevant comorbidities, or in early onset severe ICP. Consider additional postnatal investigations in women in whom resolution of abnormal liver function tests is delayed or does not occur. [Grade C] • Consider discussing the care of women with severe, very early or atypical presentation of what appears to be ICP with a hepatologist. [Grade D] • Confirm the diagnosis of ICP in the postnatal period at least 4 weeks after birth, with resolution of itching and liver function tests returning to normal (including bile acids). [Grade D] • Advise women with isolated ICP and a singleton pregnancy that the risk of stillbirth only increases above population rate once their serum bile acid concentration is 100 micromol/L or more. ⚬ In women with peak bile acids 19-39 micromol/L (mild ICP) and no other risk factors, advise them that the risk of stillbirth is similar to the background risk. Consider options of planned birth by 40 weeks' gestation or ongoing antenatal care according to national guidance. ⚬ In women with peak bile acids 40-99 micromol/L (moderate ICP) and no other risk factors, advise them that the known risk of stillbirth is similar to the background risk until 38-39 weeks' gestation. Consider planned birth at 38-39 weeks' gestation. ⚬ In women with peak bile acids 100 micromol/L or more (severe ICP), advise them that the risk of stillbirth is higher than the background risk. Consider planned birth at 35-36 weeks' gestation. [Grade A] • Advise women with ICP and a twin pregnancy that the risk of stillbirth is higher compared with a twin pregnancy without ICP. [Grade D] • Clinicians should be aware that fetal ultrasound and/or cardiotocography (CTG) do not predict or prevent stillbirth in ICP. [Grade D] This is the third edition of the guideline. The first edition was published in 2006 and the second in 2011 under the title Obstetric Cholestasis.

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Section: How Should Women Be Advised On Timing and Mode Of Birth?mentioning

confidence: 93%

“…Women and pregnant people with ICP do not have increased rates of assisted or operative birth compared with women without ICP 50 . Mode of birth should therefore be based on usual obstetric or medical indications.…”

Section: How Should Women Be Advised On Timing and Mode Of Birth?mentioning

confidence: 99%

Intrahepatic cholestasis of pregnancy

Girling¹,

Knight²,

Chappell³

2022

BJOG

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“…Moreover, the majority of early deliveries are induced and there is no evidence that this results in higher rates of emergency cesarean delivery. Indeed, it has been shown in two retrospective cohorts and one prospective study that rates of operative and instrumental delivery are not increased in women with ICP after labor induction (78)(79)(80).…”

Section: Management: Treatmentmentioning

confidence: 99%

Intrahepatic cholestasis of pregnancy: a narrative review of the management

Maritato

2021

It Journ Gyn Obs

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Intrahepatic cholestasis (ICP) is the most common liver disease in pregnancy. It is a multifactorial disease characterized by a supraphysiological rise in bile acid level associated with maternal symptoms. ICP is associated with increased incidence of some fetal complication, such as respiratory distress, premature delivery and stillbirth. For these reasons early recognition, a specific monitoring and appropriate treatment during pregnancy are necessary to improve fetal outcome. However, the optimum management and the best time of delivery still remain unclear. The purpose of this review is to evaluate and compare the most recent definitions and guidelines for intrahepatic cholestasis of pregnancy, trying to provide a global overview improving early diagnosis and adequate management. SOMMARIOLa colestasi intraepatica (ICP) è la più comune malattia epatica in gravidanza. È una malattia a origine multifattoriale, caratterizzata da un incremento della concentrazione degli acidi biliari associato a sintomi materni. Inoltre, la colestasi gravidica si associa a un'aumentata incidenza di alcune complicanze fetali, come ad esempio la sindrome da distress respiratorio, il parto pretermine e la morte intrauterina. Per questo motivo, una diagnosi precoce, un monitoraggio specifico dei markers biochimici e sintomi caratteristici di questa patologia e un appropriata terapia durante la gravidanza, sono fondamentali per ridurre le complicanze fetali. Tuttavia, il management ottimale di questa malattia e il momento migliore in cui indurre o espletare il parto non sono ancora chiari. L'obiettivo di questa review è analizzare e confrontare tra loro gli studi clinici e linee guida più recenti presenti in letteratura sulla colestasi intraepatica in gravidanza, con l'intento di fornire informazioni più dettagliate per definire i criteri diagnostici utili per la diagnosi precoce e stabilire i più adeguati protocolli diagnostici per curare la colestasi gravidica e ridurre così le sue complicanze materno-fetali.

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Serum bile acids in intrahepatic cholestasis of pregnancy: Not just a diagnostic test

Bull

Vargas

2014

Hepatology

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Operative delivery rates following induction of labour for obstetric cholestasis

Cited by 3 publications

References 4 publications

Intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis of pregnancy: a narrative review of the management

Serum bile acids in intrahepatic cholestasis of pregnancy: Not just a diagnostic test

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