Predicting fetal outcome in intrahepatic cholestasis of pregnancy: Is the bile acid level sufficient?

Intrahepatic cholestasis of pregnancy-current achievements and unsolved problems

“…This raises a crucial question: is the fasting TBA level sufficient to predict fetal outcome? Evaluation of bile acid concentrations may take several days even in major laboratories, making it an impractical tool for immediate risk stratification [70] . Therefore, it is important to evaluate other clinical factors that are possibly associated with prematurity.…”

“…However, no test reliably predicts the risk of fetal demise [62,63] . Intended to recognize a failing placenta, fetal cardiac monitoring cannot forecast an acute event such as an umbilical cord entanglement or a sudden fetal cardiac decompensation or arrhythmia [70] . As the majority of intrauterine fetal deaths in singleton pregnancies complicated by ICP occur after 37 wk, delivery has been recommended no later than 37-38 wk of gestation.…”

Pregnancy-Associated Liver Disorders

“…Serum cholic acid increases more than chenodeoxycholic acid, resulting in a marked elevation of the cholic/chenodeoxycholic acid ratio compared to pregnant women without ICP; a simultaneous decrease in the glycine/taurine conjugates ratio also occurs [107]. The frequency of fetal complications rises with serum bile acid concentrations greater than 40 lM/l [70,108,109]. Serum transaminase elevation usually accompanies hypercholangemia and reaches three-to fourfold above the upper limit of normal, although in severe cases 100-fold elevations have been reported.…”

The Liver in Pregnancy

“…A relationship between maternal serum bile acid levels and fetal distress has been found [24], and evaluation of the serum bile acid concentration has been suggested as a mean of fetal assessment in patients with ICP [25]. At the present time, however, no consensus has been reached concerning the usefulness of evaluating the serum bile acid concentrations in the obstetric management of patients with ICP [26]. Little or no correlation has been found between the serum total bile acid concentration and other liver test values [22].…”