Medical Care

Antenatal testing, including umbilical artery Doppler studies, biophysical profile (BPP), and nonstress tests, have all been performed to reduce the risk of stillbirth.^{[53, 54, 55]}One study demonstrated that increased fetal testing and scheduled induction with documentation of fetal lung maturity in patients with ICP lessened perinatal mortality rates compared with patients who were not tested.^[56] Another study concluded that bile acids above 100 μmol/L were associated with increased mortality despite twice-weekly antenatal testing.^[57]A study by Kohari et al examined the effectiveness of an intensive surveillance system for women with total bile acids >40 μmol/L at < 36 weeks. The intensive surveillance included inpatient admission and continuous FHR monitoring with delivery between 36 and 37 weeks. The authors noted a significant reduction in the stillbirth rate with this intensive surveillance strategy.^[58]

Delivery is commonly recommended at 37 weeks’ without an amniocentesis for fetal lung maturity due to increased risk of fetal mortality, or after an amniocentesis for delivery prior to 37 weeks’ gestation. If meconium is present at the time of amniocentesis, delivery is indicated regardless of the fetal lung maturity results. Delivery can proceed without an amniocentesis if the fetal monitoring is nonreassuring. Some providers are now waiting until 38-39 weeks gestation to deliver if there is resolution of pruritus symptoms with treatment and bile acid levels are not significantly elevated (less than 40 micromol/L).

Complications

A retrospective case-control study by Furrer et al found no differences in postpartum blood loss in women with intrahepatic cholestasis of pregnancy treated with ursodeoxycholic acid and with a planned delivery at 38 weeks of gestation.^[59]

Medication

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Author

Fidelma B Rigby, MD Associate Professor, Department of Obstetrics and Gynecology, Section of Maternal-Fetal Medicine, Virginia Commonwealth University Medical Center

Fidelma B Rigby, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Stacey Ehrenberg-Buchner, MD Fellow in Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Michigan Health System

Stacey Ehrenberg-Buchner, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Society for Maternal-Fetal Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Ronald M Ramus, MD Professor of Obstetrics and Gynecology, Director, Division of Maternal-Fetal Medicine, Virginia Commonwealth University School of Medicine

Ronald M Ramus, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, Medical Society of Virginia, Society for Maternal-Fetal Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Suzanne R Trupin, MD, FACOG Clinical Professor, Department of Obstetrics and Gynecology, University of Illinois College of Medicine at Urbana-Champaign; CEO and Owner, Women's Health Practice; CEO and Owner, Hada Cosmetic Medicine and Midwest Surgical Center

Suzanne R Trupin, MD, FACOG is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, International Society for Clinical Densitometry, AAGL, North American Menopause Society, American Medical Association, Association of Reproductive Health Professionals

Disclosure: Nothing to disclose.

Acknowledgements

George A VanBuren, MD Assistant Professor, Department of Reproductive Biology, Case Western Reserve University School of Medicine

George A VanBuren, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists

Disclosure: Nothing to disclose.