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

TY - JOUR

T1 - Obstetric cholestasis, outcome with active management

T2 - a series of 70 cases

AU - Kenyon, Anna P

AU - Piercy, C Nelson

AU - Girling, J

AU - Williamson, C

AU - Tribe, R M

AU - Shennan, A H

PY - 2002/3

Y1 - 2002/3

N2 - 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.

AB - 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.

KW - Adolescent

KW - Adult

KW - Birth Weight

KW - Cesarean Section

KW - Cholestasis

KW - Delivery, Obstetric

KW - Female

KW - Gestational Age

KW - Humans

KW - Obstetric Labor, Premature

KW - Pregnancy

KW - Pregnancy Complications

KW - Pregnancy Outcome

KW - Prospective Studies

KW - Pruritus

UR - http://www.scopus.com/inward/record.url?scp=0036516338&partnerID=8YFLogxK

M3 - Article

C2 - 11950183

VL - 109

SP - 282

EP - 288

JO - BJOG

JF - BJOG

IS - 3

ER -