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• W4200534514 abstract "Intrahepatic cholestasis of pregnancy (ICP) is associated with significant risk of stillbirth1. According to Society for Maternal-Fetal Medicine guidance2, while patients with bile acids (BA) >100 umol/L should undergo 36 week delivery, patients with BA < 100 umol/L can be delivered between 36-39 weeks gestational age (GA) with stratification based on BA level, and clinical cholestasis should not be delivered prior to 37 weeks. The aim of this study was to compare our institutions’ practices to recent recommendations. This was a retrospective cohort study of births with ICD-10 codes for ICP within a four-hospital system. Six month intervals from January 2018 to June 2020 were studied due to reported seasonal variations in ICP. Severity of ICP was divided into categories: BA >100, BA 40-99, BA 10-39, and clinically diagnosed ICP (BA < 10 or not drawn). Statistics were performed by chi-square for proportions, and ANOVA for continuous variables. There were 455 planned deliveries associated with ICP in the study period without time-based changes (χ2 NS). The average GA at delivery was 37 weeks with a downtrend by BA (37.2 for clinical ICP, 37.1 for BA 10-39, 36.4 for BA 40-99, 36 for BA >100). Three percent of patients (16) never had BA drawn and were delivered for clinical ICP only. Eighty-seven percent of cases (398) underwent induction of labor without increase in cesarean rate by BA level (25% across the groups, Chi-square NS). Across all cases, 68% could have been delayed per guidelines (179 (64%) of BA 10-39 and 49 (84%) of BA 40-99 delivered at 36-37 weeks). Seven percent of deliveries occurred at an earlier GA than recommended by the most recent SMFM guidance, with the highest rate in the BA 10-39 group (χ2 0.009). Following the new guidelines, 33 (7%) fewer patients would have undergone induction of labor prior to the recommended timeframe, and 228 (68%) patients may have delayed induction based on BA level. This suggests an opportunity for education and practice change to reduce potential neonatal morbidity associated with late preterm or early term delivery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)" @default.
• W4200534514 created "2021-12-31" @default.
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• W4200534514 date "2022-01-01" @default.
• W4200534514 modified "2023-10-18" @default.
• W4200534514 title "Trends in Gestational Age at Delivery for Intrahepatic Cholestasis and Adherence to Society Guidelines" @default.
• W4200534514 doi "https://doi.org/10.1016/j.ajog.2021.11.378" @default.
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