Background Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-related reversible hepatic disease. The clinical importance of ICP lies in neonatal and maternal ICP-associated complications which include higher rates of perinatal morbidity and mortality, increased rates of caesarean sections, increased risk of meconium staining of amniotic fluid, preterm delivery, fetal bradycardia, fetal distress and fetal demise. The underlying mechanisms associated with poor neonatal outcome have been shown to be associated with elevated maternal total serum bile acids (40 mmol/L) antenatally.
Ursodeoxycholic acid (UDCA) has shown to result in a significant improvement in symptomatic relief, biochemical markers and gestational age of delivery in patients with ICP. However, a consensus is lacking for the optimal UDCA dosing regimen.
Purpose The study is primarily to compare the effect of a high versus low dose of ursodeoxycholic acid in maternal and neonatal outcomes. This study will also determine the characteristics associated with ICP in a cohort of patients.
Material and methods Design: Retrospective cohort study as ICP is a rarely occurring hepatic disease.
Setting: Most ICP patients get diagnosed or referred to governmental hospitals located in their area of residence for inpatient and outpatient care.
Participants: ICP patients who underwent management of their disease in Ob/Gyn units between July 2016 and July 2017. Patients were identified using institutional medical records.
Main outcome measures: Maternal outcomes: Mode of delivery, gestational age at diagnosis and gestational age at delivery. Neonatal outcomes: APGAR score: 1 min, 5 min and 15 min: birthweight in g and NICU admission.
Results None of the patients had a history or concurrent diagnosis of other hepatic or biliary disease. A small proportion of both the high-dose and low-dose study population had histories of ICP in previous pregnancies: three in the high-dose group and two in the low-dose group. The mean bile acid level upon diagnosis was 19.7 mmol/L in the high-dose group paralleled to 17 mmol/L in the low-dose group. Other neonatal and maternal outcomes will be presented in the poster.
Conclusion This study failed to detect or prove the difference in the maternal and neonatal clinical outcomes between the UDCA high- and low-dose groups.
References and/or acknowledgements https://www.ncbi.nlm.nih.gov/pubmed/24901263https://www.jogc.com/article/S1701–2163(15)30544–2/pdf
No conflict of interest.
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