Relationship between early onset severe intrahepatic cholestasis of pregnancy and higher risk of meconium-stained fluid

Abstract

BackgroundIntrahepatic cholestasis of pregnancy (ICP) is the commonest gestational liver disease. The risk of adverse fetal outcome has been associated with the severity of maternal hypercholanemia after diagnosis.ObjectiveTo investigate whether there is a relationship between the severity and timing of onset of hypercholanemia and the risk of meconium-stained amniotic fluid (MSAF) and adverse neonatal events.Study designThe study included 382 pregnancies complicated by ICP managed at a referral hospital in Buenos Aires (Argentina) between June 2009 and December 2013. The patients were classified into three groups according to the severity of hypercholanemia at diagnosis; mild (10–19.9 μmol/L), moderate (20–39.9 μmol/L) and severe (≥40 μmol/L). Their clinical characteristics and pregnancy outcomes were investigated in a prospective observational study.ResultsHigher risk of MSAF was observed when ICP appeared early in gestation or when hypercholanemia was more severe. Taking both parameters into account an MSAF risk factor (MRF) was defined. Based on a model of positive/negative predictive values, a cut-off point of MRF = 3 was selected, which prioritized sensitivity versus specificity. In ICP patients with MRF>3, the probability of MSAF was enhanced 4-fold. An increase in the frequency of MSAF was also associated with higher serum levels at diagnosis of alanine transaminase, alkaline phosphatase and direct bilirubin.ConclusionsThe risk of MSAF is associated not only with the magnitude of hypercholanemia at diagnosis but also with the early gestational onset of raised maternal serum bile acids.

Predictors of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy

“…According to the literature, it seems that ICP patients have an increased risk of preeclampsia and gestational diabetes [6,7,9]. Our study also found that the rate of gestational diabetes in ICP patients was higher than in women with normal pregnancies, but there was no difference in preeclampsia.…”

“…The rate of cholestasis of pregnancy in our study was 2% and the rate of severe ICP was found to be 33% in all ICP patients. In previous studies, the incidence of cholestasis of pregnancy was 0.7-1.5% in the UK and severe ICP was observed in 15% of all ICP patients [6][7][8]. This ratio was found to be higher in our region.…”

“…We demonstrated that in ICP patients diagnosed before 34 weeks of gestation, the frequency of perinatal complications, especially foetal distress and meconium-stained amniotic fluid, are increased. Estiu et al also reported an association between meconiumstained amniotic fluid and lower gestational age both at diagnosis and at birth in 382 ICP patients [7]. Similarly, it was stated by Madazlı et al that foetal complications such as preterm delivery, RDS and IUGR were significantly higher in patients who were diagnosed before 30 weeks than after 34 weeks of gestation [10].…”

Obstetric Cholestasis: Comparison of Maternal and Perinatal Outcome of Ursodeoxycholic Acid versus Placebo

“…in her study showed a prevalence of 35.6% in primigravida patients and 64.4% in multigravida patients. 25 A local study at Agha khan hospital Karachi also showed a high prevalence of 57% among primigravidas. 26 The reason for this difference is not clear.…”

Intrapartum Trans-Cervical Amnioinfusion as Adjuvant to Conventional Management of Women Had Ruptured Membranes With Thick Meconium-Stained Amniotic Fluid.

“…Higher risk of MSAF is associated with early onset of intrahepatic cholestasis of pregnancy and raised maternal serum bile acids (7) .…”