Clinical outcome in a series of cases of obstetric cholestasis identified via a patient support group


Dr C. Williamson, Maternal and Fetal Disease Group, Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, UK.


Objective  To explore the clinical features of obstetric cholestasis pregnancies in UK white Caucasians.

Design  A questionnaire survey.

Setting  Study coordinated at Queen Charlotte's Hospital.

Population  Clinical features of 352 affected pregnancies in 227 Caucasian women identified via a patient support group.

Methods  Evaluation of the gestation at which prematurity and intrauterine death occur, and recording of additional clinical features in pregnancies complicated by obstetric cholestasis.

Main outcome measures  The timing of pregnancies complicated by intrauterine death and prematurity.

Results  Among the affected pregnancies, 23 (7%) were complicated by intrauterine death (20 singletons and 3 twins) and 133 (38%) were delivered prematurely (56 spontaneous and 77 iatrogenic). Eighteen of the 20 singleton intrauterine deaths occurred after 37 weeks. All three intrauterine deaths in twin pregnancies occurred before 37 weeks. Pruritus started earlier in pregnancies complicated by spontaneous prematurity, but not in those complicated by intrauterine death.

Conclusions  Intrauterine death in singleton pregnancies complicated by obstetric cholestasis death mainly occurs after 37 weeks. The gestation at which pruritus is first reported may help to predict spontaneous prematurity.