Cohort Study of Suspected Obstetric Cholestasis — What have We Learned?

Abstract

Objectives: To re-determine the local prevalence of obstetric cholestasis, and to study the presentations, diagnosis, and maternal and neonatal outcomes of obstetric cholestasis in a local cohort.
Methods: All the case records for patients with suspected obstetric cholestasis from 2003 to 2010 in the Department of Obstetrics and Gynaecology, Kwong Wah Hospital were identified and reviewed. The cases were separated into confirmed obstetric cholestasis and non–obstetric cholestasis. Comparison was then made between the two groups for maternal characteristics and neonatal outcomes. Maternal and neonatal outcomes were also compared with the annual departmental statistics for all deliveries from 2003 to 2010. Further subgroup analysis was performed for those women diagnosed with obstetric cholestasis by the higher cut-off level of serum bile acids at 40 μmol/L.
Results: Fifteen cases of obstetric cholestasis were confirmed among 41 suspected cases. When compared with the departmental statistics for all deliveries, obstetric cholestasis was significantly associated with high risk of maternal pre-eclampsia, higher rates of induction of labour and emergency Caesarean section delivery, prematurity of <37 weeks of gestation, and special baby care unit admission. Bile acid level of ≥40 μmol/L was associated with preterm delivery of <37 weeks.
Conclusions: The incidence of obstetric cholestasis was low in this locality and was associated with a high risk of prematurity and pre-eclampsia. However, obstetric cholestasis seems to run a more benign course in this population than in other regions, and management should be individualised. Conservative management can be considered, especially if the bile acid level is <40 μmol/L.