ABSTRACT
Our objective was to examine whether delivery at 37 weeks of gestation alters adverse
pregnancy outcomes in Latina patients with intrahepatic cholestasis of pregnancy (ICP).
We conducted a retrospective chart review of Latina patients who delivered at our
institution coded with ICP between 2000 and 2007. During this time period it was our
practice to offer delivery to patients with ICP at 37 weeks of gestation. Subjects
were classified into three groups according to total bile acid (TBA) concentration:
< 20 μmol/L (mild ICP), ≥ 20 μmol/L and < 40 μmol/L (moderate ICP), and ≥ 40 μmol/L
(severe ICP). Meconium passage was observed in no births in patients with mild IC,
but was found in 18% of deliveries with moderate/severe ICP. The risk of meconium
passage increased linearly, with a 19.7% increased risk for each 10 μmol/L increase
in TBA concentration (p = 0.001). There was no association with higher TBA concentration and other adverse
outcomes. There was no difference in adverse outcomes between moderate and severe
ICP. We concluded that in our Latina population with ICP, an association existed between
meconium passage and moderate/severe ICP. Delivering at 37 weeks was associated with
a low risk of adverse outcomes due to ICP among all patients, including those with
higher TBA concentrations.
KEYWORDS
Cholestasis - pregnancy - delivery - management
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Richard H LeeM.D.
Women's and Children's Hospital, 1240 N. Mission Road
Room 5K-40, Los Angeles, CA 90033; reprints not available from the author
