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Management and complications of 343 women with obstetric cholestasis in the united kingdom in 2009–2010
  1. V Gurung1,
  2. L C Chappell2,
  3. J Chambers3,
  4. P Seed2,
  5. C Williamson3,
  6. J G Thornton1
  1. 1University of Nottingham, Nottingham, UK
  2. 2King's College London, London, UK
  3. 3Imperial College London, London, UK

Abstract

Background There are few contemporaneous data on management and complications of women with obstetric cholestasis (OC) in the UK. Many case series date from the 1970s–1990s.

Methods We undertook a prospective study of every woman who had bile acids measured across nine maternity units in the UK for the duration of a parallel intervention trial in 2009–2010 (101 months total). Outcome data were obtained from case record review.

Results During the study period, 45 775 women were delivered across the nine units, of whom 472 were identified as having raised bile acids. In 343 (0.7% of all deliveries), the diagnosis of OC was confirmed.

192 women (56%) were induced for OC. 94 women (27%) were delivered by caesarean section (8 emergency pre-labour, 41 elective pre-labour, 45 emergency in-labour). 57 women (17%) had an operative delivery for fetal compromise.

Of 362 babies, there was one perinatal death (pre-labour, with co-existent diabetes). 21 (5.8%) infants were admitted to the neonatal unit; six required ventilation and three needed oxygen therapy for >12 h. There was one case of confirmed neonatal septicaemia, but no cases of intraventricular haemorrhage, convulsions or retinopathy of prematurity.

Discussion This is one of the largest recent studies of women with OC capturing women through bile acid measurement rather than a patient support group or informal referral and thus gives a more accurate representation of perinatal complications associated with OC. These data will help guide recommendations for management.

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Footnotes

  • Funding Research for Patient Benefit programme, National Institute for Health Research.

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