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PFM.41 Obstetric cholestasis: What is the future for its diagnosis and management
  1. M Naughton1,
  2. D Anumba1,2
  1. 1University of Sheffield, Sheffield, UK
  2. 2Sheffield Teaching Hospitals NHS, Sheffield, UK

Abstract

Aim Obstetric cholestasis (OC) is an incompletely understood hepatobiliary disease that typically affects women in the third trimester of pregnancy. It is associated with increased morbidity and mortality for the fetus, including intrauterine fetal death (IUFD). However, the diagnosis is complex and requires exclusion of other pregnancy-related complications and the serological measurements used are non-specific. A sensitive and specific diagnostic test is needed to help simplify diagnosis. Mothers with obstetric cholestasis are managed by early induction of labour or caesarean section, to try and prevent IUFD. This practice lacks conclusive evidence of benefit; with evidence that expectant management has equivalent outcomes. 1,2 A prognostic test to identify high-risk fetuses is needed to prevent unnecessary inventions in potentially uncomplicated pregnancies. Method: Using Ovid SP Medline, Web of Science and the Cochrane library. The literature relevant to emerging diagnostic and prognostic tests was identified. The papers were synthesised to identify likely candidates for further research and incorporation into the diagnosis and management of obstetric cholestasis. Discussion: Potential candidates for providing a sensitive and specific test for obstetric cholestasis were identified. Autotaxin is a promising candidate that merits further study. 3 Potential prognostic tests were found that identify fetuses with a higher risk of complications. Serum bile acid level and cardiotocography have been shown to be ineffective screening tools. Umbilical artery Doppler pulsatility index and systolic/diastolic ratio correlate well with fetal outcome and could be used as a screening tool. 4 There remains a need to review current management protocols for OC informed by best evidence.

References

  1. Chappell LC, Gurung V, Seed PT, et al. Ursodeoxycholic acid versus placebo, and early term delivery versus expectant management, in women with intrahepatic cholestasis of pregnancy: semifactorial randomised clinical trial. British Medical Journal. Jun 13 2012;344

  2. Marschall HU, Shemer EW, Ludvigsson JF, Stephansson O. Intrahepatic cholestasis of pregnancy is not associated with intrauterine fetal death but with gestational diabetes and preeclampsia. Gastroenterology. May 2012;142(5):S912–S913

  3. Kremer AE, Dixon PH, Ris-Stalpers C, et al. Autotaxin is a novel diagnostic marker for intrahepatic cholestasis of pregnancy. Journal of Hepatology. Mar 2011;54:S11–S12

  4. Zhang K, He J, Dong M. Relationship between umbilical artery Doppler waveform analysis and perinatal prognosis in women with intrahepatic cholestasis of pregnancy. International Journal of Gynecology and Obstetrics. Nov 2010;111(2):187–188

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