Dr Vanessa Bowden1, Dr Rebecca Mann1, Dr Ruth Hughes1,2
1Christchurch Women's Hospital, Te Whatu Ora Waitaha, Christchurch, New Zealand, 2Department of Obstetrics and Gynaecology, University of Otago, Christchurch, New Zealand
Biography:
Vanessa Bowden is a fourth year RANZCOG trainee and has a budding interest in Maternal Fetal Medicine and high-risk obstetrics . She is currently working in Christchurch and plays golf in her spare time.
Abstract:
Introduction: Intrahepatic cholestasis of pregnancy (ICP) affects up to 1% of all pregnancies (higher in certain ethnicities) and should be suspected when a pregnant person presents with pruritus without a rash. It is confirmed if bile salts are elevated in the absence of pre-existing liver disorders and resolves after pregnancy. ICP contributes to neonatal morbidity from preterm birth (both spontaneous and iatrogenic) and rarely is stillbirth when bile salts are significantly elevated, as well as maternal morbidity with debilitating itch and sleep deprivation. Optimal timing of delivery may need to be individualised according to peak bile salts and other relevant pregnancy morbidity. In 2023 the Society of Obstetric Medicine of Australia and New Zealand (SOMANZ) introduced a guideline on the management, surveillance and delivery of these pregnancies. We aim to review the management of ICP in our hospital and compare it to current international guidelines as well as our own hospital’s.
Methods: We are performing a retrospective clinical audit of cases of ICP in a tertiary level centre over a 2-year timeframe. Laboratory results and both electronic and physical clinical records will be reviewed.
Results: We will report on maternal demographics, peak bile salts and liver function results, time of day and frequency of sample collection, the use of ursodeoxycholic acid, delivery circumstances including gestation, mode and whether delivery was planned or spontaneous, and neonatal outcomes. We will also report on whether postpartum resolution was confirmed.
Discussion: Information is intended to be useful in updating our centre’s guideline and ensure women under our care are receiving a consistent approach which is evidence based or best practice, where evidence may not be clear. Our next steps will be to update our hospital guideline and re-audit following its implementation.
Keywords
Cholestasis, Guidelines
References
Hague, W.M., Briley, A., Callaway, L., Dekker Nitert, M., Gehlert, J., Graham, D., Grzeskowiak, L., Makris, A., Markus, C., Middleton, P., Peek, M.J., Shand, A., Stark, M. and Waugh, J. Intrahepatic cholestasis of pregnancy – Diagnosis and management: A consensus statement of the Society of Obstetric Medicine of Australia and New Zealand (SOMANZ): Executive summary. Aust N Z J Obstet Gynaecol [Internet]. 2023 [cited 2024 May 25]; 63: 656-665. https://doi.org/10.1111/ajo.13719