During a 5-year period there were 30 193 deliveries at Kingston Hospital. There were 73 women who had bile acids of above 14 micromol/l and a diagnosis of suspected obstetric cholestasis. Comparison was made with the Kingston Hospital's background population.
Results Incidence of obstetric cholestasis (OC) was 2.4 per 1000, median age of patients was 33 years (IQR 6), median gestational age at delivery was 37 weeks (IQR 2) and median serum bile acid measured 36 micromol/l (IQR 44). 55% of cases were primigravidas and 86% were Caucasian in origin.
Compared to the background population, rates of twin pregnancy (13.7%), preterm labour (27.4%), induction of labour (49.3%), meconium staining (21.9%) and neonatal unit admission (15.1%) were all significantly raised. There was a single stillbirth. There was no statistically significant difference in the rates of Caesarean section (34.2%) and postpartum haemorrhage ≥1000 ml (5.5%).
Within the OC cohort a serum bile acid threshold of >40 micromol/l was significantly associated with higher rates of twin pregnancy (24.2%) and preterm delivery (45.5%).
Conclusion This retrospective study concludes that in the Kingston hospital experience, obstetric cholestasis is associated with higher rates of twins, preterm labour, induction rates and meconium staining and neonatal unit admissions. However, there is no statistically significant difference in the rates of caesarean section and PPH.
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