[Perinatal outcomes in patients with cholestasis of pregnancy].

BACKGROUND: Obstetric cholestasis has been associated with an increased risk of preterm delivery, intrapartum meconium, foetal distress and intrauterine foetal death. There is no consensus about the frequency of each of these complications or about the prognostic value of serum bile acids and transaminase levels. Bile acids levels above 40pml/L have been associated with adverse perinatal outcomes.

OBJECTIVES: To determine the frequency of adverse perinatal outcomes in single pregnancies with cholestasis of pregnancy and assess the association between levels of bile acids and transaminases in maternal serum, together with peninatal outcomes.

MATERIAL AND METHOD: Retrospective descriptive study of 71 women diagnosed of intrahepatic cholestasis in the years 2006-201 1 in the University of Vigo Clinical Hospital Complex (Spain).

RESULTS: The mean gestational age at the diagnostic was 35 weeks 6 days, being 10% of babies premature. There was one intrauterine foetal death (1 .4%). We found 18.3% intrapartum meconium. Caesarean sections were performed in 5.6% of the deliveries due to foetal distress. No neonate presented Apgar < 7, or PH in the umbilical artery < 7. The 75,5% of infants did not present respiratory distress, while 5 (6.75%) presented serious distress. We found no statistically significant association between adverse perinatal outcomes and the level of bile acids. High levels of transaminases were related to prematurity (p = 0.009; p =0.010) and severe distress (p = 0.027; p =0.008).

CONCLUSION: The low frequency of adverse outcomes observed in our series could be in relation to the low rate of prematurity. Neither the biochemical nor clinical features are suitable for predicting foetal complications.