At what gestational age should a pregnancy with cholestasis of pregnancy be terminated
38 weeks Historically obstetric cholestasis was thought to be benign disease. Biochemical abnormalities and pruritus in obstetric cholestasis persists until delivery following which resolution occurs. - Pruritus usually improves within 1 week liver function tests returns to normal in 3-7 days in the majority and 4-6 weeks postnatally in the remainder. Adverse obstetric outcomes with cholestatic pregnancy was .first quantified by Fisk who repoed an overall perinatal moality of 70 per 100 live bih and intrauterine deaths of 30 per 1000 pregnancies. - There is an increased risk of intrauterine death, classically. .from 37 weeks gestation, an increased risl of ineconium passage and increased risk of preterm labour. - The mechanism of intrauterine death is unceain but is likely to be related to a toxic effect on the fetus. This resulted in a policy of active management for obstetric cholestasis. - "With active management and elective delivery at 37 to 38 weeks, the perinatal moality reduced to zero".
34 weeks
36 weeks
38 weeks
40 weeks