Predicting Fetal Asphyxia in Intrahepatic Cholestasis of Pregnancy

Abstract

Oligohydramnios occurs in about 2.3% of pregnancies and is threatening to fetal health. Hydration has been hypothesized to be an effective way of decreasing the occurrence of the condition because the likelihood for oligohydramnios increases with maternal dehydration. Several studies have shown that both serum and oral hydration therapies are effective treatments for oligohydramnios. The amniotic fluid index (AFI) is the most commonly used quantitative indicator of amniotic fluid volume. This randomized controlled clinical trial evaluated the efficacy of acute maternal hydration on increasing AFI in 44 pregnant Iranian women who were diagnosed by sonography to have oligohydramnios (defined as 2.1 Ͻ AFI Ͻ 6 cm). The participants were randomly divided into 2 groups: an intervention group (n ϭ 22) receiving oral hydration (2 liters of water within 2 hours) and a control group (n ϭ 22) receiving routine amounts of water. AFI and urinary specific gravity were measured in both groups at baseline and following intervention.Before treatment, the mean AFI was 50.8 in the intervention group and 52.1 in the control group. After treatment, the mean AFI increased to 67.2 in the intervention group whereas the AFI in the control group (52.5) remained close to the baseline value (P Ͻ 0.001, t test ϭ 3.827). There was a marked increase in the mean urinary specific gravity after treatment (intervention: 13.4 vs. control: 1.68) (P Ͻ 0.001, t test ϭ 3.956).These findings are consistent with previous studies showing that acute oral hydration is an effective, noninvasive, easily accessible and inexpensive treatment to increase AFI. OBSTETRICS Volume 65, Number 3 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACTActive management of the third stage of labor (AMTSL) is more effective in reducing postpartum hemorrhage than expectant management. Widespread implementation of AMTSL in remote and rural areas, however, is hampered by the lack of availability of an efficacious, easily administered, safe, and storable oxytocic. Two parenterally administered oxytocics, methyl ergometrine, and oxytocin, have a number of drawbacks in addition to their routes of administration. Methylergometrine is associated with the occurrence of life-threatening complications, and oxytocin requires careful handling and storage due to thermal-and photolability. In previous studies, a synthetic prostaglandin E1 analog, misoprostol has shown promise as an effective oxytocic agent. This agent is affordable, stable at room temperature, has a long-shelf, and can be administered orally or by other routes.This double-blind randomized trial compared the effectiveness of sublingual misoprostol with that of intravenous oxytocin, and intravenous methylergometrine in reducing blood loss during the third and fourth stages of labor. A total ABSTRACTThe major cause of immune hemolytic disease of the newborn (HDN) in developed countries is ABO incompatibility. HDN due to ABO incompatibility is considered a high risk condition because it leads to early onset hyperbilirubinemia, due to...

Association of severe intrahepatic cholestasis of pregnancy with adverse pregnancy outcomes: A prospective population‐based case‐control study

“…Our findings of increased risks of adverse perinatal outcomes in ICP are consistent with previous smaller studies that reported preterm delivery, fetal asphyxia, and meconium staining in white‐European and Latina populations . Previous work has led to uncertainty over the risks of stillbirth; early studies suggested an increased risk but were considered subject to case ascertainment bias, while later reports suggested lower rates of stillbirth, largely attributed to policies of active management, with increased antenatal fetal monitoring and elective delivery at around 37 weeks' gestation.…”

“…Our findings of increased risks of adverse perinatal outcomes in ICP are consistent with previous smaller studies that reported preterm delivery, fetal asphyxia, and meconium staining in white-European and Latina populations. [4][5][6][7][8]23 Previous work has led to uncertainty over the risks of stillbirth; early studies suggested an increased risk but were considered subject to case ascertainment bias, while later reports suggested lower rates of stillbirth, largely attributed to policies of active management, with increased antenatal fetal monitoring and elective delivery at around 37 weeks' gestation. Interestingly, the most recent study of fetal outcomes in ICP showed no significant increase in the number of stillbirths in an actively managed ICP population compared to controls during the study period (1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)).…”

“…However, only 96 women (19%) had bile acids exceeding this level. 3 Although these findings have been partially replicated in other populations, [6][7][8]10 no studies have been large enough to evaluate the relationship between maternal serum bile acids and stillbirth. Furthermore, there have been no prospective studies examining the relationship between maternal nonfasting serum bile acid levels and perinatal outcomes.…”

“…1,2 There are accumulating data indicating that the risk of fetal complications relates to high levels of circulating bile acids. [3][4][5][6][7][8][9][10] One prospective cohort study from Sweden examined the relationship between adverse fetal outcomes and maternal serum bile acid levels; there was a 1%-2% increased risk of spontaneous preterm delivery, asphyxial events, and meconium-stained amniotic fluid with every 1 lmol/L increase in maternal serum bile acids, but this was not statistically significant until the fasting maternal serum bile acid level exceeded 40 lmol/L. However, only 96 women (19%) had bile acids exceeding this level.…”

Intrahepatic cholestasis of pregnancy

“…The study conducted by Glantz et al 14 in Swedish women was followed by several other studies [15][16][17][18][19][20][21][22][23] (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.…”