Stillbirth and associated perinatal outcomes in obstetric cholestasis: a systematic review and meta-analysis of observational studies

Abstract

Background Obstetric cholestasis is a condition occurring in pregnancy with suspected adverse perinatal outcomes. Stillbirth is a significant adverse event associated with obstetric cholestasis and considered for intervention in pregnancy. Objectives There are multiple studies with epidemiological data with regards to the outcomes of obstetric cholestasis. Our hypothesis is to the test the association of stillbirth and related outcomes in obstetric cholestasis. Search Strategy & Selection criteria Two independent reviewers did independent searches and selection with a standardized design as outlined in the PRISMA statement. Analysis The retrieved relevant literature was subjected to a rigorous quality assessment and followed by standardized interpretable results. Results The pooled estimate in this study showed that there was no significant difference in the stillbirth rates in the obstetric (OC) population when compared to the non-obstetric cholestasis (reference) population. However, there was an increased risk of preterm birth in the OC population compared to the reference population; however, the cesarean section and induction of labor results were directly related. Discussion This study provides an epidemiological data related to the perinatal outcomes associated with obstetric cholestasis, specifically stillbirth. This result is likely to produce a benchmark for current evidence-based practice and to assist future research in understanding the implication of associated stillbirth risk and related outcomes with OC.

Perinatal Outcomes among Women with Cholestasis of Pregnancy

“…Mohan et al reported that induction of labor resulted in high cesarean section rates, but in our study, 54.6% of patients who were induced with E2 and/or E1 had a normal vaginal delivery. 24 In this study, 31 (48.4%) women had FTVD contrary to a study by Geenes and Williamson who showed that preterm deliveries were significantly associated with ICP. 13 Another study by Kong et al stated 21% of ICP occurred as premature deliveries.…”

“…20 Literature reports that postpartum hemorrhage is 2.33 times more common in pregnancies complicated by ICP as compared to pregnancies not complicated by ICP. 24 Another study in France showed 20.7% of pregnant women with ICP had PPH. Our study shows one woman (1.5%) to have PPH, contrary to the above studies (p = 0.032 b ).…”

Prediction of stillbirth: an umbrella review of evaluation of prognostic variables

“…After screening abstracts, 266 full‐text papers were retrieved for review, of which 197 were excluded (Figure 1, Table S1a). Sixty‐nine systematic reviews were included 3,9,17,23–88 …”

Does ursodeoxycholic acid have a role in the treatment of women with intrahepatic (obstetric) cholestasis of pregnancy anymore?

“…A systematic review and individual patient data meta-analysis published in 2019 examined epidemiological studies for the association of stillbirth and associated outcomes in relation to obstetric cholestasis. Its findings were that obstetric cholestasis is associated with increased rates of both iatrogenic and spontaneous preterm births, meconium-stained amniotic fluid, neonatal unit admission and increased risk of stillbirth only when peak serum bile acid concentrations were 100 µmol/L or higher, therefore challenging the previous widely held belief that obstetric cholestasis is associated with increased stillbirth rates across all bile acid concentrations 3…”