What are the indications of intrauterine fetal demise from intrahepatic cholestasis of pregnancy (CIP)?

Updated: Jan 14, 2019
  • Author: Fidelma B Rigby, MD; Chief Editor: Ronald M Ramus, MD  more...
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Answer

Intrauterine fetal demise is also associated with ICP, especially if the total bile acid level is elevated and/or jaundice is present, but it rarely occurs prior to 36 weeks’ gestation. [35, 36, 37] In a study by Glantz et al, fetal complications including preterm delivery, meconium staining of the amniotic fluid and the placenta, and fetal asphyxia were related to bile acid concentration with the critical level of 40 micromol/L or greater. [42]

A study by Kawakita et al found that in women with ICP, total bile acid level ≥100 μmol/L was associated with increased risk of stillbirth. The authors also added that TBA ≥40 μmol/L was associated with increased risk of meconium-stained amniotic fluid. [43]

In summary, the current consensus favors twice-weekly nonstress testing with or without Doppler testing and induction at 37 weeks.


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