Protocol Management of Cholestasis of Pregnancy [32R]

Abstract

INTRODUCTION: Intrahepatic Cholestasis of Pregnancy (ICP) is associated with intrauterine fetal demise (IUFD) and severity of disease is associated with higher rates of IUFD. Antepartum management of (ICP) is highly variable. Consensus in clinical practice is to encourage delivery at 37 weeks regardless of severity. We evaluated if standardizing the management of ICP based on bile acid level would affect maternal and neonatal outcomes. METHODS: Women diagnosed with ICP and delivered at our hospital were prospectively followed from 01/02/2012-01/01/2018. Maternal and neonatal outcomes were evaluated before and after institution of a standardized management protocol. A 6 month wash-out period was utilized. Statistical methods performed included the Chi Square test, Fischer exact probability test and the two sample t-test. IRB approval was obtained and standards upheld. RESULTS: Ninety-two patients were included in the analysis. The bile acid level was higher in the post guideline group 69 umol/L vs the pre guideline group 30 umol/L (p =0.002). No difference was noted in the cesarean rate (p=0.56), NICU admissions (p=0.075), or 5 minute APGAR (p=0.609). The rate of composite neonatal respiratory morbidity was higher in the post guideline group (p=0.0023). There was one IUFD in the post-guideline group that occurred at 28 weeks in the setting of a twin pregnancy and bile acids of 264. CONCLUSION: Induction at 39 weeks for pregnancies with bile acids 20 or less did increase composite neonatal respiratory morbidity. Guidelines and standardization of care for cholestasis of pregnancy would help reduce variability between providers and deliveries prior to 39 weeks.