Obstetric cholestasis, outcome with active management: a series of 70 cases

Abstract

OBJECTIVE: To determine the nature and outcome of obstetric cholestasis in a United Kingdom population. DESIGN: Prospective analysis of clinical outcome in women diagnosed with obstetric cholestasis that is actively managed. SETTING: Antenatal population of three London hospitals between August 1999 and April 2001. POPULATION: Seventy women with obstetric cholestasis defined as abnormal liver function (one or more abnormality in gamma-glutamyl transpeptidase, alanine amino-transferase, aspartate amino-transferase and total bile acids) in a pregnant woman with pruritus, in the absence of other pathology. METHODS: All women were interviewed weekly regarding their symptoms. All were actively managed according to a standardised protocol, which included early delivery before 38 weeks. Obstetric outcome was recorded. RESULTS: Seventy women of mean age 30 (6) years delivered 73 infants. The median gestation at onset of pruritus was 30 (range 4-39) weeks and at diagnosis of obstetric cholestasis was 33.7 (range 21-40.7) weeks. Asian women were more likely to be diagnosed with obstetric cholestasis. Pruritus was usually severe and generalised, and commonly worst on the palms and/or soles of the feet. There were no stillbirths or perinatal deaths. Twenty-five women required caesarean section (36%); only four (16%) were for fetal distress. Twelve women (17%) delivered before 37 weeks, of which eight (67%) were iatrogenic. Ten (14%) infants required admission to the special care baby unit of which four (40%) were ventilated. CONCLUSIONS: Policies of active management result in increased intervention and associated complications. This must be balanced against possible reductions in perinatal mortality.