Pregnancy outcome in patients with intrahepatic cholestasis of pregnancy in a single German Center

Introduction:

The clinical management of patients with intrahepatic cholestasis of pregnancy (ICP) is still a controversially discussed issue among clinicians. In fact, the Green-top guideline of the RCOG considers ICP as a risk factor for spontaneous preterm birth, iatrogenic preterm birth and fetal death. Treatment with ursodesoxycholic acid and induction of labour at 37+0 weeks of gestation are recommended as standards for clinical practice. A german guideline for the management of ICP does currently not exist.

Objective:

This study aims to review diagnostic procedures and clinical management, as well as maternal and neonatal outcomes in patients with ICP.

Methods:

In this retrospective cohort-review, we included 103 patients with ICP, who presented to our perinatal center between January 2011 and December 2017.

Discussion and conclusion:

In our Department, we commonly monitor maternal and fetal well-being weekly in patients with ICP and offer induction of labor at 37+0 weeks of pregnancy. Patients are informed of the increased risk of perinatal morbidity due to early induction and of possible failure of induction. In our cohort, maternal as well as neonatal morbidity and mortality were not significantly elevated due to ICP. We observed no stillbirths. However, a high percentage of patients had additional co-morbidities such as gestational diabetes, hypertensive disorders, cervical insufficiency and virus hepatitis putting them at risk for adverse outcomes.