Prise en charge de la cholestase intrahépatique gravidique en France : enquête nationale des pratiques auprès des gynécologues-obstétriciens

Arlicot, C.; Louarn, A. Le; Bacq, Yannick; Potin, J.; Denis, C.; Perrotin, F.

doi:10.1016/j.jgyn.2011.09.003

Cited by 7 publications

(1 citation statement)

References 37 publications

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“…Coinciding with the results of this survey Saleh & Abdo demonstrate that most British obstetricians perform CTG (84%), ultrasound examinations (82%) and monitor umbilical artery Doppler velocimetry (77%) in ICP-affected pregnancies [ 22 ]. The authors of the French study further concluded that the potential of an IUFD is overestimated by their participants, resulting in a high significance of fetal monitoring [ 23 ]. Since the studies were carried out years ago and new insights like the significance of bile acids exceeding 100 µmol/L and the risk of an IUFD have been published, it remains unclear how managements of ICP might have changed over the time.…”

Section: Discussionmentioning

confidence: 99%

Intrahepatic cholestasis of pregnancy: an evaluation of obstetric management in German maternity units

Zehner

Mai

Dückelmann

et al. 2022

Arch Gynecol Obstet

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Purpose Intrahepatic cholestasis of pregnancy (ICP) is associated with adverse fetal and neonatal outcome. Evidence for improvement by obstetric management is sparse. Common international guidelines recommend induction of labor before term, however, they differ in recommendations of monitoring the disease and time point of active management. So far, an official guideline for treatment and management of ICP in Germany does not exist. This study aims to compile common practice and policy in obstetric management of ICP in German maternity units. The objective is to gather obstetricians’ opinion on management of ICP, and to estimate the need for standardization of current practice in Germany on the background of existing evidence. Methods A questionnaire focusing on indications for interventions was developed including fourteen multiple-choice questions comprising the areas of diagnostic criteria, laboratory testing, fetal monitoring, treatment, and delivery timing. The survey was sent to 699 maternity clinics and was distributed to participants of the annual congress hosted by the German society of perinatal medicine (DGPM). Collected data were summarized and evaluated in relation to available evidence and existing guidelines. Descriptive statistics and Fisher's exact test were used. Results 334 completed questionnaires returned corresponding to a response rate of 48.1%. Coinciding with existing international guidelines, 48.8% of the participants acknowledge bile acid concentrations above 10 µmol/L to be indicative of ICP. 85.0% of obstetricians recommend antenatal testing with cardiotocography, exceeding common standards of maternity policy guidelines; 50.3% execute active management in ICP-affected pregnancies as they generally recommend a delivery between 37 + 0 and 38 + 6 weeks of gestation. Although recent studies evinced a risk of stillbirth in ICP-affected pregnancies not until a bile acid concentration of > 100 µmol/L, 22.2% of the respondents recommend delivery before 37 + 0 weeks of gestation due to raised bile acids of 40–99 µmol/L. Conclusions Opinions on the management of ICP in German maternity units differ widely and partly deviate by large from international standards. Reasons for this may be the lack of a national guideline and the low awareness due to the rarity of the disease on the one hand and the very slow dynamics in evidence generation and thus the uncertainty about the actual risks and optimal management on the other. The present data highlight the need for further research and clinical guidelines to standardize and optimize treatment based on the best available evidence.

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Section: Discussionmentioning

confidence: 99%