Risks of emergency cesarean section and fetal asphyxia after induction of labor in intrahepatic cholestasis of pregnancy: A hospital-based retrospective cohort study

Shemer, Elisabeth Andrea Wikström; Thorsell, Malin; Marschall, Hanns‐Ulrich; Kaijser, Magnus

doi:10.1016/j.srhc.2012.11.005

Cited by 25 publications

(16 citation statements)

References 128 publications

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“…However, pregnant women with ICP whose labor was induced by oxytocin, required emergency cesarean sections less frequently. It was reported that bile acids, which increase uterine contractility, reduce the delivery duration and the need for emergency cesarean section by removing the possible fetal distress [22]. The need for urgent cesarean section was detected as 24.5% in multiparous pregnant women with ICP who had vaginal delivery previously, in our study.…”

Section: Discussionsupporting

confidence: 47%

“…Also, no difference was observed in terms of the first and second stage of the delivery periods of pregnant women with ICP compared with the control group. It was found that the rate of emergency cesarean sections in women with and without ICP whose deliveries began spontaneously were similar [22]. However, pregnant women with ICP whose labor was induced by oxytocin, required emergency cesarean sections less frequently.…”

Section: Discussionmentioning

confidence: 95%

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The severity of intrahepatic cholestasis of pregnancy can shorten the first stage of labor in multiparous women induced by prostaglandin E2

et al. 2020

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Aim: To determine the relationship between increased serum bile acid concentrations and the first stage of labor in multiparous women induced by vaginal prostaglandin E2 (PGE2) with intrahepatic cholestasis of pregnancy (ICP). Material and Methods: In this retrospective case-control study 283 multiparous women with ICP and 283 healthy multiparous pregnant women were admitted for induction of delivery, were inserted PGE2 (10 mg dinoprostone) vaginally. The groups with mild, moderate and severe ICP were compared with control group in terms of the time from beginning of PGE2 vaginal insertion to active phase of labor, the time from beginning of PGE2 vaginal insertion to complete dilatation of cervix and fetal outcomes. Results: The time from beginning of PGE2 insertion to active phase in the mild, moderate and severe ICP groups were shorter than in the non-ICP group; 3.19±0.32, 7.26±0.34, 8.71±0.35 hours, respectively (p<0.01). The time from beginning of PGE2 insertion to complete dilatation of cervix in the groups with mild, moderate and severe ICP were shorter than in non-ICP group; 3.03 ± 0.45; 10.33 ± 0.62; 14.44 ± 0.53, respectively (p<0.01). There was no difference between the groups in terms of fetal outcomes except fetal weight and the presence of meconium (p<0.01). Conclusion: Increased bile acid concentrations in multiparous pregnant women induced by vaginal PGE2 with mild, moderate and severe ICP are associated with shorter duration of cervical ripening and labor induction time to delivery. The study concluded that multiparous women with ICP can deliver faster as the severity of cholestasis increases.

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Section: Discussionsupporting

confidence: 47%

Section: Discussionmentioning

confidence: 95%

The severity of intrahepatic cholestasis of pregnancy can shorten the first stage of labor in multiparous women induced by prostaglandin E2

et al. 2020

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“…An individualised decision should be taken when considering the optimal mode of delivery in women with ICP. There is no evidence that either spontaneous onset of labour or induction of labour result in an increased rate of emergency caesarean section in women with ICP compared with women with uncomplicated pregnancy …”

Section: Strategy For Deliverymentioning

confidence: 99%

“…The study conducted by Glantz et al . in Swedish women was followed by several other studies (including 10–5477 women) in different populations, including Hispanic, Turkish, Dutch and Swedish women. Although these studies generally support the findings of increased rates of meconium staining of the amniotic fluid, low Apgar scores at 5 minutes and preterm birth, the retrospective nature or small sample size in these studies makes interpretation difficult.…”

Section: Associated Adverse Perinatal Outcomesmentioning

confidence: 99%

Intrahepatic cholestasis of pregnancy

Geenes

Williamson

Chappell

2016

The Obstetric & Gynaecologis

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Key content Obstetric cholestasis is also known as intrahepatic cholestasis of pregnancy (ICP). ICP affects approximately 0.7% of pregnant women in the UK, equating to approximately 6000 women per year. Pruritus, elevated liver enzymes and raised serum bile acids are key to the diagnosis of ICP. There is an increased risk of adverse perinatal outcomes associated with severe ICP, including spontaneous preterm birth, meconium staining of the amniotic fluid and stillbirth. ICP may be treated with ursodeoxycholic acid (UDCA), with some improvement in serum biochemistry and pruritus; however, the impact on the fetus is uncertain. Learning objectives To understand the presentation, investigation and management options for women with ICP. To appreciate the perinatal implications of ICP. To be aware of the differential diagnoses for antenatal and postnatal abnormal liver function tests. Ethical issues Use of unlicensed drugs in pregnancy. Uncertain feto‐protective benefits of UDCA. Implications of the adoption of early elective delivery on the development of children born to women with ICP.

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“…The elevation of SBA has been associated with increased neonatal respiratory distress syndrome [2] [3], premature delivery [4], fetal asphyxia [5] and mortality [6]. The placenta has key roles in the regulation of fetal growth and development during pregnancy [7].…”

Section: Introductionmentioning

confidence: 99%

Bile Acid Effects on Placental Damage in Intrahepatic Cholestasis of Pregnancy

Xie¹,

Liu²,

Xiao³

et al. 2018

JBM

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Aims: The abnormal increase of bile acid is found in intrahepatic cholestasis of pregnancy (ICP). It also can be observed the damage of placental tissue in ICP. The aim of this study was to find the associations of the bile acid in umbilical vein and the damage of placental tissue. Methods: Thirty women diagnosed with ICP and fifty normal pregnant women between September 2015 and September 2017 at Nanshan District Maternity & Child Healthcare Hospital of Shenzhen were included in this study. The glycocholic acid (GA), total bile acids (TBA), total bilirubin (TB), direct bilirubin (DB) and albumin level in umbilical vein were measured by cycle enzyme method in ICP and control group. The placental damage was analyzed by morphologic study using hematoxylin dyes in two groups. The correlation between the level of the bile acid in the umbilical vein and the damage of the placenta was assessed using SPSS software. Results: The GA, TBA, TB, DB and albumin level in umbilical vein were significantly higher in ICP than those of pregnant women, respectively. The placental villis were expanded and the structure was destroyed in ICP. The vessel was damaged and the cell trophoblast hyperplasia in ICP. It also can be seen that there was obvious nodules and a typical fibrous necrotic substance in ICP but not in control group. There is a positive correlation between the level of the TBA in the umbilical vein and the damage of the placenta in ICP. Conclusion: The TBAs were significantly higher in umbilical vein and were related to the placental damage in ICP.

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Risks of emergency cesarean section and fetal asphyxia after induction of labor in intrahepatic cholestasis of pregnancy: A hospital-based retrospective cohort study

Cited by 25 publications

References 128 publications

The severity of intrahepatic cholestasis of pregnancy can shorten the first stage of labor in multiparous women induced by prostaglandin E2

The severity of intrahepatic cholestasis of pregnancy can shorten the first stage of labor in multiparous women induced by prostaglandin E2

Intrahepatic cholestasis of pregnancy

Bile Acid Effects on Placental Damage in Intrahepatic Cholestasis of Pregnancy

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