Obstetric cholestasis, outcome with active management: a series of 70 cases

Objective To determine the nature and outcome of obstetric cholestasis in a United Kingdom population. Design Prospective analysis of clinical outcome in women diagnosed with obstetric cholestasis that is actively managed. Setting Antenatal population of three London hospitals between August 1999 an...

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Veröffentlicht in:	BJOG : an international journal of obstetrics and gynaecology Jg. 109; H. 3; S. 282 - 288
Hauptverfasser:	Kenyon, Anna P., Piercy, C. Nelson, Girling, J., Williamson, C., Tribe, R.M., Shennan, A.H.
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	Oxford, UK Blackwell Science Ltd 01.03.2002 Blackwell
Schlagworte:	Adolescent Adult Biological and medical sciences Birth Weight Cesarean Section Cholestasis - therapy Delivery, Obstetric - methods Diseases of mother, fetus and pregnancy Female Gestational Age Gynecology. Andrology. Obstetrics Humans Medical sciences Obstetric Labor, Premature - etiology Pregnancy Pregnancy Complications - therapy Pregnancy Outcome Pregnancy. Fetus. Placenta Prospective Studies Pruritus - etiology Pruritus - therapy Human Pregnancy disorders Indication Treatment efficiency Biliary tract disease Pregnancy Symptomatology Clinical management Treatment Surgery Adolescent Cholostasis Digestive diseases Adult Evolution Female Cesarean section
ISSN:	1470-0328, 1471-0528
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Abstract	Objective To determine the nature and outcome of obstetric cholestasis in a United Kingdom population. Design Prospective analysis of clinical outcome in women diagnosed with obstetric cholestasis that is actively managed. Setting Antenatal population of three London hospitals between August 1999 and April 2001. Population Seventy women with obstetric cholestasis defined as abnormal liver function (one or more abnormality in gamma‐glutamyl transpeptidase, alanine amino‐transferase, aspartate amino‐transferase and total bile acids) in a pregnant woman with pruritus, in the absence of other pathology. Methods All women were interviewed weekly regarding their symptoms. All were actively managed according to a standardised protocol, which included early delivery before 38 weeks. Obstetric outcome was recorded. Results Seventy women of mean age 30 (6) years delivered 73 infants. The median gestation at onset of pruritus was 30 (range 4–39) weeks and at diagnosis of obstetric cholestasis was 33.7 (range 21–40.7) weeks. Asian women were more likely to be diagnosed with obstetric cholestasis. Pruritus was usually severe and generalised, and commonly worst on the palms and/or soles of the feet. There were no stillbirths or perinatal deaths. Twenty‐five women required caesarean section (36%); only four (16%) were for fetal distress. Twelve women (17%) delivered before 37 weeks, of which eight (67%) were iatrogenic. Ten (14%) infants required admission to the special care baby unit of which four (40%) were ventilated. Conclusions Policies of active management result in increased intervention and associated complications. This must be balanced against possible reductions in perinatal mortality.
AbstractList	To determine the nature and outcome of obstetric cholestasis in a United Kingdom population. Prospective analysis of clinical outcome in women diagnosed with obstetric cholestasis that is actively managed. Antenatal population of three London hospitals between August 1999 and April 2001. Seventy women with obstetric cholestasis defined as abnormal liver function (one or more abnormality in gamma-glutamyl transpeptidase, alanine amino-transferase, aspartate amino-transferase and total bile acids) in a pregnant woman with pruritus, in the absence of other pathology. All women were interviewed weekly regarding their symptoms. All were actively managed according to a standardised protocol, which included early delivery before 38 weeks. Obstetric outcome was recorded. Seventy women of mean age 30 (6) years delivered 73 infants. The median gestation at onset of pruritus was 30 (range 4-39) weeks and at diagnosis of obstetric cholestasis was 33.7 (range 21-40.7) weeks. Asian women were more likely to be diagnosed with obstetric cholestasis. Pruritus was usually severe and generalised, and commonly worst on the palms and/or soles of the feet. There were no stillbirths or perinatal deaths. Twenty-five women required caesarean section (36%); only four (16%) were for fetal distress. Twelve women (17%) delivered before 37 weeks, of which eight (67%) were iatrogenic. Ten (14%) infants required admission to the special care baby unit of which four (40%) were ventilated. Policies of active management result in increased intervention and associated complications. This must be balanced against possible reductions in perinatal mortality. Objective To determine the nature and outcome of obstetric cholestasis in a United Kingdom population. Design Prospective analysis of clinical outcome in women diagnosed with obstetric cholestasis that is actively managed. Setting Antenatal population of three London hospitals between August 1999 and April 2001. Population Seventy women with obstetric cholestasis defined as abnormal liver function (one or more abnormality in gamma‐glutamyl transpeptidase, alanine amino‐transferase, aspartate amino‐transferase and total bile acids) in a pregnant woman with pruritus, in the absence of other pathology. Methods All women were interviewed weekly regarding their symptoms. All were actively managed according to a standardised protocol, which included early delivery before 38 weeks. Obstetric outcome was recorded. Results Seventy women of mean age 30 (6) years delivered 73 infants. The median gestation at onset of pruritus was 30 (range 4–39) weeks and at diagnosis of obstetric cholestasis was 33.7 (range 21–40.7) weeks. Asian women were more likely to be diagnosed with obstetric cholestasis. Pruritus was usually severe and generalised, and commonly worst on the palms and/or soles of the feet. There were no stillbirths or perinatal deaths. Twenty‐five women required caesarean section (36%); only four (16%) were for fetal distress. Twelve women (17%) delivered before 37 weeks, of which eight (67%) were iatrogenic. Ten (14%) infants required admission to the special care baby unit of which four (40%) were ventilated. Conclusions Policies of active management result in increased intervention and associated complications. This must be balanced against possible reductions in perinatal mortality. To determine the nature and outcome of obstetric cholestasis in a United Kingdom population.OBJECTIVETo determine the nature and outcome of obstetric cholestasis in a United Kingdom population.Prospective analysis of clinical outcome in women diagnosed with obstetric cholestasis that is actively managed.DESIGNProspective analysis of clinical outcome in women diagnosed with obstetric cholestasis that is actively managed.Antenatal population of three London hospitals between August 1999 and April 2001.SETTINGAntenatal population of three London hospitals between August 1999 and April 2001.Seventy women with obstetric cholestasis defined as abnormal liver function (one or more abnormality in gamma-glutamyl transpeptidase, alanine amino-transferase, aspartate amino-transferase and total bile acids) in a pregnant woman with pruritus, in the absence of other pathology.POPULATIONSeventy women with obstetric cholestasis defined as abnormal liver function (one or more abnormality in gamma-glutamyl transpeptidase, alanine amino-transferase, aspartate amino-transferase and total bile acids) in a pregnant woman with pruritus, in the absence of other pathology.All women were interviewed weekly regarding their symptoms. All were actively managed according to a standardised protocol, which included early delivery before 38 weeks. Obstetric outcome was recorded.METHODSAll women were interviewed weekly regarding their symptoms. All were actively managed according to a standardised protocol, which included early delivery before 38 weeks. Obstetric outcome was recorded.Seventy women of mean age 30 (6) years delivered 73 infants. The median gestation at onset of pruritus was 30 (range 4-39) weeks and at diagnosis of obstetric cholestasis was 33.7 (range 21-40.7) weeks. Asian women were more likely to be diagnosed with obstetric cholestasis. Pruritus was usually severe and generalised, and commonly worst on the palms and/or soles of the feet. There were no stillbirths or perinatal deaths. Twenty-five women required caesarean section (36%); only four (16%) were for fetal distress. Twelve women (17%) delivered before 37 weeks, of which eight (67%) were iatrogenic. Ten (14%) infants required admission to the special care baby unit of which four (40%) were ventilated.RESULTSSeventy women of mean age 30 (6) years delivered 73 infants. The median gestation at onset of pruritus was 30 (range 4-39) weeks and at diagnosis of obstetric cholestasis was 33.7 (range 21-40.7) weeks. Asian women were more likely to be diagnosed with obstetric cholestasis. Pruritus was usually severe and generalised, and commonly worst on the palms and/or soles of the feet. There were no stillbirths or perinatal deaths. Twenty-five women required caesarean section (36%); only four (16%) were for fetal distress. Twelve women (17%) delivered before 37 weeks, of which eight (67%) were iatrogenic. Ten (14%) infants required admission to the special care baby unit of which four (40%) were ventilated.Policies of active management result in increased intervention and associated complications. This must be balanced against possible reductions in perinatal mortality.CONCLUSIONSPolicies of active management result in increased intervention and associated complications. This must be balanced against possible reductions in perinatal mortality.
Author	Tribe, R.M. Shennan, A.H. Piercy, C. Nelson Kenyon, Anna P. Girling, J. Williamson, C.
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Keywords	Human Pregnancy disorders Indication Treatment efficiency Biliary tract disease Pregnancy Symptomatology Clinical management Treatment Surgery Adolescent Cholostasis Digestive diseases Adult Evolution Female Cesarean section
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Snippet	Objective To determine the nature and outcome of obstetric cholestasis in a United Kingdom population. Design Prospective analysis of clinical outcome in women... To determine the nature and outcome of obstetric cholestasis in a United Kingdom population. Prospective analysis of clinical outcome in women diagnosed with... To determine the nature and outcome of obstetric cholestasis in a United Kingdom population.OBJECTIVETo determine the nature and outcome of obstetric...
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SubjectTerms	Adolescent Adult Biological and medical sciences Birth Weight Cesarean Section Cholestasis - therapy Delivery, Obstetric - methods Diseases of mother, fetus and pregnancy Female Gestational Age Gynecology. Andrology. Obstetrics Humans Medical sciences Obstetric Labor, Premature - etiology Pregnancy Pregnancy Complications - therapy Pregnancy Outcome Pregnancy. Fetus. Placenta Prospective Studies Pruritus - etiology Pruritus - therapy
Title	Obstetric cholestasis, outcome with active management: a series of 70 cases
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