Postpartum Blood Loss in Women Treated for Intrahepatic Cholestasis of Pregnancy

Abstract

OBJECTIVE To evaluate postpartum blood loss in women with treated intrahepatic cholestasis of pregnancy. METHODS In a retrospective case-control study, 15,083 deliveries including 348 women with intrahepatic cholestasis of pregnancy (2.3%) were analyzed from 2004 to 2014. To adjust for differences in baseline characteristics, a propensity analysis was performed and women in the control group were matched to the women in the intrahepatic cholestasis of pregnancy group in a 5:1 ratio. , meconium staining (14.5% compared with 11.4%, P=.12), and number of stillbirths after 26 weeks of gestation (0.6% compared with 1.8%, P=.10) were not significantly different in the study compared with the control group. In moderate and severe intrahepatic cholestasis of pregnancy, meconium staining was observed significantly more often compared with that in a control group (23.0% and 32.3% compared with 11.4%, P<.01). There was no correlation between estimated blood loss or ΔHb and severity of intrahepatic cholestasis of pregnancy. CONCLUSIONS In our cohort of women with intrahepatic cholestasis of pregnancy who are treated with ursodeoxycholic acid and have planned delivery (induction of labor or planned cesarean delivery) at 38 weeks of gestation, no differences in postpartum blood loss were seen.

Women successfully treated for severe intrahepatic cholestasis of pregnancy do not have increased risks for adverse perinatal outcomes

“…[16] Additionally, various reports have suggested that severe ICP but not mild ICP is associated with poorer perinatal outcomes when compared to control populations. For example, Furrer et al found that MSAF was observed more often in women with severe ICP than in women without ICP, [17] while Raz et al determined that severe ICP increased the risk of preeclampsia, as compared with controls. [18] Notably, Glantz et al reported that the risk of fetal complications (spontaneous preterm delivery, asphyxia, and MSAF) increased by 1% to 2% per additional μmol/L of SBA above 40 μmol/L.…”

“…[14–16] Furthermore, several studies have provided evidence that, compared with control populations, severe ICP is associated with adverse fetal and maternal outcomes (including spontaneous preterm delivery, fetal asphyxia, MSAF, and preeclampsia) whereas mild ICP is not. [3,17,18] Furthermore, for maternal SBA levels >40 μmol/L, significant relationships were identified between SBA level and preterm delivery, spontaneous preterm delivery, stillbirth, and MSAF. [19] However, it remains unknown whether the risk of adverse perinatal outcomes remains elevated in women who are initially diagnosed with severe ICP but whose SBA levels are subsequently maintained <40 μmol/L by treatment.…”

Association of Adverse Perinatal Outcomes of Intrahepatic Cholestasis of Pregnancy With Biochemical Markers: Results of Aggregate and Individual Patient Data Meta-Analyses

“…Cui et al 37 Furrer et al 24 Kowalska-Kańka et al 38 Zhang et al 26 Ataalla et al 36 15 countries, from five continents, were included in the aggregate data meta-analysis, whereas IPD data were available from 14 countries, from five continents.…”

Outcome of Pregnancy Complicated by Obstetric Cholestasis

“…Incidence of OC in present study is 5%. Padmaja et 11 al and Ge et al found highest incidence of 8.2% and 6.5% respectively whereas Hafeez et al, 12 Sohail et al, 13 Furrer et al 14 and Rook et al 15 found lower incidence of OC that is 3.1%, 2.8%, 2.3% and 1.9% respectively. The cause of so much variation from present study is may be due to geographical variation, ethnicity, environmental factor, different food habits or sample size calculation.…”