Introduction: Obstetric cholestasis (OC) or intrahepatic cholestasis of pregnancy (ICP) is associated with increased pregnancy risk as well as anxiety and depression in the mother. This study therefore determined the prevalence of OC in the Australian Capital Territory (ACT) and the pregnancy outcomes associated with OC.
Methodology: A retrospective clinical audit review was performed at The Canberra Hospital (TCH). Data was gained from the hospital’s Birth Outcomes System (BOS). All other pregnancies were compared to OC pregnancies, to determine prevalence, management, and pregnancy outcomes.
Results: There were 10364 total pregnancies during the study period. The prevalence of OC pregnancies (n=66) was 0.64% as compared to all other pregnancies (n=10298). The primary clinical outcomes of OC, included a medium gestational age at delivery of 37 compared to 39+3 weeks (***p<0.001), and despite an earlier gestational birth age, there was no increase in NICU admission (*p<0.05). There was an increased likelihood of having an induction of labour (***p<0.001), and an increased likelihood of twin pregnancies and gestational diabetes mellitus (GDM) in the OC group (***p<0.001). The rates of caesarean section and perinatal mortality did not differ significantly (p>0.05) with 37.9% versus 28.4%, and 1.2% versus 1.5%, between OC pregnancies and all other pregnancies, respectively. Results also show that the majority of OC patients had pruritus (98.5%), deranged LFTs (87.9%), and elevated bile acids (83.3%). It was also observed that the majority of patients were managed with ursodeoxycholic (65.2%), with symptoms treated with antihistamines (30.3%), emollients (4.5%), and both antihistamines and emollients (13.6%).
Conclusion: This study found a correlation between OC and DM, and that the current clinical evaluation is reliable in capturing those with OC. Furthermore, this study demonstrated a significant relationship between OC and twin birth rates.