A RETROSPECTIVE STUDY ON INTRAHEPATIC CHOLESTASIS OF PREGNANCY: MARKERS OF PREMATURE DELIVERY

Background: Intrahepatic Cholestasis of Pregnancy (ICP) carries with it a higher frequency of premature delivery (20 to 60%), a marker ofperinatal morbility/mortality. Therefore, it is important to identify markers of premature delivery. Aim: To retrospectively evaluate, in a large case study, the presence of markers predictive of premature delivery. Materials and Methods: Clinical records of all patients diagnosed with ICP in Policlinic S.Orsola-Malpighi (Bologna, Italy) from January 2001 until December 2007 have been collected. For all patients the following informations were available: subjective pruritus evaluation, standard biochemical parameters, serum bile acids (BA) determination, abdomen ultrasonography and APGAR index. From diagnosis until a week after delivery, biochemistry and fetal health have been controlled weekly. Student’s t Test, Mann-Whitney, Pearson’s correlation test and a stepwiselogistic regression analysis were performed as appropriate. Results: 169 clinical records have been gathered. Patients with premature delivery, compared to those who delivered closer to term, presented a significantly earlier appearance of pruritus (r = 0.4858) and higher levels of chenodeoxycholic acid (r = −0.2835). No significant differences were observed for APGAR index and rate of fetal complications according to treatment and time of delivery. Two fetal deaths occurred (fetal infection by Parvovirus B19 and haemolysis for ABO incompatibility) before week 34 with serum BA below 20 mM/l. According to the multivariate analysis, the only variable associated with preterm delivery is the early onset of cholestasis, that exposes to a risk twice than normal (OR = 2.044; 95% CI 1.40−2.98; p = 0.0002). Conclusions: The strongest predictor of premature delivery in our population is the time of onset of pruritus with an OR of 2.044.