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Poster session I Clinical obstetrics, epidemiology, fetus, medical-surgical complications, neonatalogy, physiology/endocrinology, prematurity: Abstracts 87 - 236| Volume 208, ISSUE 1, SUPPLEMENT , S84, January 01, 2013

172: Induction of labor at less than 38 weeks in cholestasis of pregnancy: a six-year cohort

      Objective

      The purpose of this study is to evaluate the effectiveness of our institutional protocol for the active management of cholestasis of pregnancy.

      Study Design

      From Jan. 1, 2006 to Dec. 31, 2011, 332 patients were diagnosed with cholestasis of pregnancy (pruritus associated with Total Bile Acids >14mg/dl) and managed using a single institutional protocol. The protocol recommended the induction of labor for women diagnosed with mild (TBA <40) and severe cholestasis (TBA ≥ 40) between 36 and 38 weeks gestation after verifying lung maturity via amniocentesis. Patients diagnosed with severe disease between 34-36 weeks were also offered amniocentesis to verify lung maturity and to rule out the presence of meconium. The average TBA level, the average gestational age at delivery, birthweight, primary cesarean delivery rate, stillbirths, and the incidence of respiratory distress syndrome were reviewed.

      Results

      Out of the 332 women diagnosed, 195 underwent induction of labor at less than 38 weeks. The average TBA level for the cohort was 54.45 +/− 33.0mg/dl. The average gestational age at time of delivery was 36.52 +/− 0.95 weeks. The average birthweight was 2902 +/− 320gm. The primary cesarean was 12.8% (16/125) for those induced <38 weeks and 12.8% (25/195) for all patients induced. This compares favorably with our institutions' primary cesarean rate over this time period of 14.5%. The incidence of respiratory distress was also not increased versus our general obstetric population. There were 3 stillbirths recorded with an adjusted stillbirth incidence of 1 out of 332 pregnancies.

      Conclusion

      This study is the largest prospective U.S. cohort to date. Our institutional protocol for the management of cholestasis reduces perinatal morbidity and mortality without increasing the primary cesarean rate or the incidence of respiratory distress syndrome. Induction of labor between 36-38 weeks is a viable clinical option for patients diagnosed with cholestasis of pregnancy.