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Lower Caesarean section rates in women induced for obstetric cholestasis
  1. CF Rosales,
  2. F Lamb,
  3. P Ayuk
  1. Royal Victoria Infirmary, Newcastle upon Tyne, UK

Abstract

Introduction There remains uncertainty regarding the management and timing of delivery of women with obstetric cholestasis (OC). RCOG guidelines indicate that risks associated with OC may be lower than formerly thought. Previous studies have found an increased risk of caesarean section (CS) in women with OC (up to 36%).

The authors examined the outcomes for OC, specifically those induced, in a tertiary referral centre with 6500 deliveries / year.

Method Data were collected retrospectively for 63 women diagnosed with OC who delivered between 8 April 2008 and 30 May 2009. OC was diagnosed on the basis of symptoms and raised bile acids.

Results 34 (54%) women were primiparous. The median gestational age at diagnosis was 34 weeks (13–40). 51 (81%) women received ursodeoxycholic acid, 58 (92%) had raised bile acids, the same number had raised AST. Median gestation at delivery was 37 weeks (32–40), 54 (86%) women were induced. Of these there were 37 (69%) spontaneous vaginal deliveries, 13 (24%) assisted vaginal deliveries and 4 (7%) CS. During the same period, the CS rate for all induced labours (n =1177) was 21.7%.

There were no stillbirths or perinatal deaths in the women with OC, but 4 babies were admitted to the special care baby unit.

Discussion The authors found a lower than expected CS rate in women induced for OC. Further studies are underway to compare outcomes for induced labour in OC to those for women with pre-eclampsia and postdates pregnancies.

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