Usefulness of fetal monitoring in intrahepatic cholestasis of pregnancy: a prospective study

Abstract

Doppler investigation of the umbilical artery might be of some value in recognition of the specific risk of fetal compromise in pregnancies complicated by intrahepatic cholestasis.

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

“…There are conflicting reports on Doppler ultrasound findings. Guerra et al concluded that there were no significant changes in any of the blood flow velocity indices determined by umbilical Doppler blood flow analysis in ICP 94 , while a recent study found significantly increased Doppler flow velocities in ICP despite normal cardiotocography (CTG) 95 . In agreement with this finding, a case of stillbirth in ICP has been observed within 8 hours following a normal CTG 96 .…”

“…Induction of labor at gestational weeks 37-38 has been advocated to prevent obstetric complications by prolonged pregnancy and to possibly reduce the risk of stillbirth, since stillbirth in ICP in previous studies tended to cluster at this age of gestation 3,7 and is unpredictable by conventional fetal surveillance 95,97 . Since this kind of active management of ICP is already common practice in many countries, it is very difficult to perform sufficiently powered randomized prospective trials to evaluate this concept 91 , in particular, as the overall incidence of stillbirth is very low.…”

Role of postprandial bile acids in prediction of perinatal outcome in intrahepatic cholestasis of pregnancy

“…Until now, several clinical and laboratory parameters have been investigated for their role as predictors of fetal complications in ICP, including bile salts, transaminases, coagulation parameters and Doppler indices. 2,[10][11][12] To the best of our knowledge, postprandial bile acids and their relation to perinatal outcome have not been investigated in ICP. The aim of this study was to evaluate TBA levels in fasting and postprandial state as potential predictors of fetal outcome along with other biochemical and clinical parameters.…”

Intrahepatic cholestasis of pregnancy: Relationship between bile acid levels and maternal and fetal complications

“…Placental dysfunction as it is mentioned by He et al is the other possible cause of intrauterine fetal loss. For this reason, Doppler examination of the fetal umbilical arteries during the follow-up of fetuses in patients with ICP is enounced as a valuable method ( 23 ) . However, presence of acute anoxia signs rather than chronic anoxia features, presence of correlated fetal weights with the other fetuses at the same gestational age, and presence of normal umbilical artery signs in the examination of fetuses who were lost due to ICP asserted the cause of fetal death due to acute toxic effects of SBA rather than chronic placental insufficiency ( 24 ) .…”