OBJECTIVE: To evaluate postpartum blood loss in women with treated intrahepatic cholestasis of pregnancy. METHODS: In a retrospective case-control study, 15,083 deliveries including 348 women with intrahepatic cholestasis of pregnancy (2.3%) were analyzed from 2004 to 2014. To adjust for differences in baseline characteristics, a propensity analysis was performed and women in the control group were matched to the women in the intrahepatic cholestasis of pregnancy group in a 5:1 ratio. Blood loss was analyzed by estimated blood loss and Δ hemoglobin (Hb, difference between prepartum and postpartum Hb). A subgroup analysis regarding severity of intrahepatic cholestasis of pregnancy based on maximum bile acid level (mild [less than 40 micromoles/L], moderate [40-99 micromoles/L], and severe intrahepatic cholestasis of pregnancy [100 micromoles/L or greater]) was performed. Differences in estimated blood loss, ΔHb, and meconium staining between subgroups were analyzed. A Spearman rank correlation was performed to evaluate the association of bile acid levels and blood loss within subgroups. RESULTS: Estimated blood loss (median 400 [300-600] mL compared with 400 [300-600] mL, P=.22), ΔHb (14.0 [5.0-22.0] compared with 12.0 [4.0-21.0] g/L, P=.09), meconium staining (14.5% compared with 11.4%, P=.12), and number of stillbirths after 26 weeks of gestation (0.6% compared with 1.8%, P=.10) were not significantly different in the study compared with the control group. In moderate and severe intrahepatic cholestasis of pregnancy, meconium staining was observed significantly more often compared with that in a control group (23.0% and 32.3% compared with 11.4%, P<.01). There was no correlation between estimated blood loss or ΔHb and severity of intrahepatic cholestasis of pregnancy. CONCLUSIONS: In our cohort of women with intrahepatic cholestasis of pregnancy who are treated with ursodeoxycholic acid and have planned delivery (induction of labor or planned cesarean delivery) at 38 weeks of gestation, no differences in postpartum blood loss were seen.
OBJECTIVE: To evaluate postpartum blood loss in women with treated intrahepatic cholestasis of pregnancy. METHODS: In a retrospective case-control study, 15,083 deliveries including 348 women with intrahepatic cholestasis of pregnancy (2.3%) were analyzed from 2004 to 2014. To adjust for differences in baseline characteristics, a propensity analysis was performed and women in the control group were matched to the women in the intrahepatic cholestasis of pregnancy group in a 5:1 ratio. Blood loss was analyzed by estimated blood loss and Δ hemoglobin (Hb, difference between prepartum and postpartum Hb). A subgroup analysis regarding severity of intrahepatic cholestasis of pregnancy based on maximum bile acid level (mild [less than 40 micromoles/L], moderate [40-99 micromoles/L], and severe intrahepatic cholestasis of pregnancy [100 micromoles/L or greater]) was performed. Differences in estimated blood loss, ΔHb, and meconium staining between subgroups were analyzed. A Spearman rank correlation was performed to evaluate the association of bile acid levels and blood loss within subgroups. RESULTS: Estimated blood loss (median 400 [300-600] mL compared with 400 [300-600] mL, P=.22), ΔHb (14.0 [5.0-22.0] compared with 12.0 [4.0-21.0] g/L, P=.09), meconium staining (14.5% compared with 11.4%, P=.12), and number of stillbirths after 26 weeks of gestation (0.6% compared with 1.8%, P=.10) were not significantly different in the study compared with the control group. In moderate and severe intrahepatic cholestasis of pregnancy, meconium staining was observed significantly more often compared with that in a control group (23.0% and 32.3% compared with 11.4%, P<.01). There was no correlation between estimated blood loss or ΔHb and severity of intrahepatic cholestasis of pregnancy. CONCLUSIONS: In our cohort of women with intrahepatic cholestasis of pregnancy who are treated with ursodeoxycholic acid and have planned delivery (induction of labor or planned cesarean delivery) at 38 weeks of gestation, no differences in postpartum blood loss were seen.
Authors: Caroline Ovadia; Paul T Seed; Alexandros Sklavounos; Victoria Geenes; Chiara Di Ilio; Jenny Chambers; Katherine Kohari; Yannick Bacq; Nuray Bozkurt; Romana Brun-Furrer; Laura Bull; Maria C Estiú; Monika Grymowicz; Berrin Gunaydin; William M Hague; Christian Haslinger; Yayi Hu; Tetsuya Kawakita; Ayse G Kebapcilar; Levent Kebapcilar; Jūratė Kondrackienė; Maria P H Koster; Aneta Kowalska-Kańka; Limas Kupčinskas; Richard H Lee; Anna Locatelli; Rocio I R Macias; Hanns-Ulrich Marschall; Martijn A Oudijk; Yael Raz; Eli Rimon; Dan Shan; Yong Shao; Rachel Tribe; Valeria Tripodi; Cigdem Yayla Abide; Ilter Yenidede; Jim G Thornton; Lucy C Chappell; Catherine Williamson Journal: Lancet Date: 2019-02-14 Impact factor: 202.731
Authors: William M Hague; Leonie Callaway; Jennifer Chambers; Lucy Chappell; Suzette Coat; Jiska de Haan-Jebbink; Marloes Dekker; Peter Dixon; Jodie Dodd; Maria Fuller; Sanne Gordijn; Dorothy Graham; Oskari Heikinheimo; Annemarie Hennessy; Risto Kaaja; Teck Yee Khong; Laura Lampio; Jennie Louise; Angela Makris; Corey Markus; Hanns-Ulrich Marschall; Philippa Middleton; Ben W Mol; Jonathan Morris; John P Newnham; Caroline Ovadia; Michael Peek; Antonia Shand; Michael Stark; Jim Thornton; Susanna Timonen; Susan Walker; David Warrilow; Catherine Williamson Journal: BMC Pregnancy Childbirth Date: 2021-01-12 Impact factor: 3.007
Authors: Carsten Hagenbeck; Ulrich Pecks; Frank Lammert; Matthi As C Hütten; Felix Borgmeier; Tanja Fehm; Ekkehard Schleußner; Holger Maul; Sven Kehl; Amr Hamza; Verena Keitel Journal: Gynakologe Date: 2021-04-20