Intrahepatic cholestasis of pregnancy and timing of delivery

Jamie O. Lo, Brian L. Shaffer, Allison J. Allen, Sarah E. Little, Yvonne W. Cheng, Aaron B. Caughey

Research output: Contribution to journalArticle

22 Scopus citations

Abstract

Objective: We examined the morbidities from delivery at earlier gestational ages versus intrauterine fetal demise (IUFD) for women with intrahepatic cholestasis of pregnancy (ICP) to determine the optimal gestational age for delivery.Methods: A decision-analytic model was created to compare delivery at 35 through 38 weeks gestation for different delivery strategies: (1) empiric steroids; (2) steroids if fetal lung maturity (FLM) negative; (3) wait a week and retest if FLM negative; or (4) deliver immediately. Literature review identified 18 studies that estimated IUFD in ICP; we used the mean rate, 1.74%, and assumed a uniform distribution from 34 to 40 weeks gestation. Large cohort data was used to calculate neonatal morbidity rates at each gestational age. Maternal and neonatal quality-adjusted life years (QALYs) were combined. Univariate sensitivity and Monte Carlo analyses were performed to test for robustness.Results: Immediate delivery at 36 weeks without FLM testing and steroid administration was the optimal strategy as compared to delivery at 36 weeks with steroids (+47 QALYs) and as compared to immediate delivery at 35 weeks (+210 QALYs). Our results were robust up to a 30% increase in the rate of IUFD.Conclusion: Immediate delivery at 36 weeks in women with ICP is the optimal delivery strategy.

Original languageEnglish (US)
Pages (from-to)2254-2258
Number of pages5
JournalJournal of Maternal-Fetal and Neonatal Medicine
Volume28
Issue number18
DOIs
StatePublished - Dec 12 2015

Keywords

  • Cholestasis
  • decision analytic model
  • gestational age
  • intrahepatic cholestasis
  • late preterm delivery
  • pregnancy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

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