Peripartal blood loss and outcome of intrahepatic cholestasis of pregnancy

Aim: Intrahepatic cholestasis of pregnancy (ICP) is associated with preterm birth, meconium staining and stillbirth. In addition, increased blood bile acids (BBA) may cause vitamin K malabsorption and hence influence blood coagulation with increased peripartal blood loss. Our goal was to evaluate feto-maternal outcome in women with ICP with attention to peripartal blood loss.

Methods: In a retrospective case-control study, 15083 deliveries including 345 women with ICP (2,3%) were analyzed from 2004 – 2014. To adjust differences in baseline characteristics a propensity analysis was performed and controls were matched to the ICP cases in a 5:1 ratio. Blood loss was analyzed by estimated blood loss (EBL) and delta hemoglobin (dHb: difference of pre-/postpartal Hb). A subgroup analysis regarding severity of ICP (mild (< 40 µmol/l BBA), moderate (40 – 100 µmol/l BBA) and severe ICP (> 100 µmol/l BBA)) was performed. Differences in EBL, dHb and meconium staining between subgroups were analyzed. A spearman rank correlation was performed to evaluate the association of ICP and blood loss within subgroups.

Results: Baseline characteristics were comparable between study and control groups. EBL (mean 515 ml vs. 494 ml, p = 0,22), dHb (14,71 vs. 13,63, p = 0,09), meconium staining (14,5% vs. 11,4%, p = 0,12) and number of stillbirths after the 26^th week of gestation (0,6% vs. 1,8%, p = 0,10) were not significantly different (study vs. control group, respectively). In severe ICP, meconium staining was observed significantly more often compared to controls (32,3% vs. 11,4%, p < 0,001). There was no correlation between EBL or dHb and severity of ICP.

Conclusions: In our collective of women with ICP, who usually receive treatment with ursodeoxycholic acid and are induced at 38 weeks of gestation, no differences in peripartal blood loss, meconium staining and stillbirths were shown. However, severe ICP is associated with meconium staining.