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

BJOG. 2002 Mar;109(3):282-8. doi: 10.1111/j.1471-0528.2002.01368.x.


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.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Birth Weight
  • Cesarean Section
  • Cholestasis / therapy*
  • Delivery, Obstetric / methods
  • Female
  • Gestational Age
  • Humans
  • Obstetric Labor, Premature / etiology
  • Pregnancy
  • Pregnancy Complications / therapy*
  • Pregnancy Outcome
  • Prospective Studies
  • Pruritus / etiology
  • Pruritus / therapy