Differentiated timing of induction for women with intrahepatic cholestasis of pregnancy - a historical cohort study.

INTRODUCTION: Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy specific liver disease characterised by pruritus and abnormal liver function tests and it has been associated with intrauterine fetal distress and stillbirth. We compared two guidelines of the management of ICP: One mandating induction at 38 weeks of gestation (Rigshospitalet and Hvidovre Hospital before 2012) and another separating ICP into a mild and severe form and only women with severe ICP were recommended induction at 38 weeks (Hvidovre Hospital after 2012).

MATERIAL AND METHODS: We performed a historical cohort study at two Copenhagen Hospitals from 2004 to 2015. We included 62,937 women with singleton deliveries at Rigshospitalet and 71,015 at Hvidovre Hospital of which 971 women (1.5%) and 998 women (1.4%) were diagnosed with ICP at Rigshospitalet and Hvidovre Hospital respectively. Data was retrieved from a local medical database. For the analysis of induction and comparison of obstetrical outcomes we only included pregnancies with an ICP diagnosis and excluded women with other medical conditions that could mandate induction. Main outcome measures were induction and cesarean section rates, asphyxia and stillbirth.

RESULTS: We found no changes in the rate of spontaneous labor, cesarean section and induction over the years at Rigshospitalet (p = 0.17) and Hvidovre Hospital (p = 0.38). For women with intended vaginal delivery we found no change in the final mode of delivery over the years at Rigshospitalet (p = 0.28) and Hvidovre Hospital (p = 0.57).

CONCLUSIONS: The two approaches to the management of mild ICP regarding the timing of induction are comparable. Women with mild ICP and their clinicians should be encouraged to engage in shared decision making when discussing timing of induction.