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Archives of Gynecology and Obstetrics

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01-10-2016 | Maternal-Fetal Medicine

Early induction of labor in high-risk intrahepatic cholestasis of pregnancy: what are the costs?

Authors: Anne Katrine Friberg, Vera Zingmark, Jens Lyndrup

Published in: Archives of Gynecology and Obstetrics | Issue 4/2016

Abstract

Purpose

Induction of labor among pregnant women with high levels of total bile acid (TBA) is common among clinicians. We examined, if women with intrahepatic cholestasis of pregnancy (ICP) and TBA ≥ 40 μmol/l have a higher risk of maternal–fetal complications, when labor is induced at 37 weeks of gestation, compared with induction of labor at term in women with low-risk ICP.

Methods

Retrospective cohort study of 16,185 women delivering at Roskilde University Hospital in the period 2006–2011. Women with high-risk ICP (TBA ≥ 40 μmol/l) had labor induced at 37 weeks of gestation; women with low-risk ICP (TBA < 40 μmol/l) at term.

Outcomes

Mode of delivery, duration of induction procedures, highest level of TBA and alanine aminotransferase (ALT) and for the neonates: Apgar scores at 5 min, umbilical cord pHs and SBEs, NICU admissions and birthweights.

Results

The incidences of ICP was 1.2 % (95 % CI 1.05–1.39 %) altogether and for high-risk ICP 0.4 % (95 % CI 0.27–0.46 %). No difference was found in mode of delivery, length of induction of labor nor in neonatal outcomes, except for an expected difference in birthweight. In high-risk ICP, ALT was not raised in 10.3 % (95 % CI 2.5–18.2 %).

Conclusion

Early induction of labor at 37 weeks of gestation seems justified in high-risk ICP, as, except for abbreviating gestational age by 9 days with 296 g smaller babies, induction of labor was not followed by detectable maternal–fetal disadvantages and is favored by an expected major reduction in ICP stillbirth risk.

Until November 25th 2009 the Reactionlab A/S—BIO-STAT Bile Acid kit (Cat.no. 495000) was used. The kit was calibrated by performing measurements in parallel with the laboratorium in Gothenburg that performed the analyses in the large Swedish prospective study by A. Glantz (1) and was accordingly corrected by a factor 40/30; later a Sentinel Bile Acids TBA (REF 6K9001) were used and calibrated against its standard.

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Title: Early induction of labor in high-risk intrahepatic cholestasis of pregnancy: what are the costs?
Authors: Anne Katrine Friberg
Vera Zingmark
Jens Lyndrup
Publication date: 01-10-2016
Publisher: Springer Berlin Heidelberg
Published in: Archives of Gynecology and Obstetrics / Issue 4/2016
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-016-4019-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Early induction of labor in high-risk intrahepatic cholestasis of pregnancy: what are the costs?

Abstract

Purpose

Methods

Outcomes

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Outcomes

Results

Conclusion

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