Obstetrics & Gynecology

Skip Navigation LinksHome > February 2009 - Volume 113 - Issue 2, Part 2 > Sudden Fetal Death in Intrahepatic Cholestasis of Pregnancy

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Obstetrics & Gynecology:
doi: 10.1097/AOG.0b013e31818db1c9
Case Reports

Sudden Fetal Death in Intrahepatic Cholestasis of Pregnancy

Lee, Richard H. MD; Incerpi, Marc H. MD; Miller, David A. MD; Pathak, Bhuvan MD; Goodwin, T Murphy MD

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Abstract

BACKGROUND: Intrahepatic cholestasis of pregnancy is associated with an increased risk of fetal death. The mechanism of death is unknown.

CASES: The first case involved a young primipara with pruritus and a bile acid concentration of 79 μmol/dL. While undergoing fetal heart rate monitoring, the fetus had a prolonged deceleration resulting in intrauterine death. The second case involved a young multipara with cholestasis who received ursodeoxycholic acid. Her bile acid concentration improved to13 μmol/dL. At 34 weeks of gestation, she had uterine contractions with prolonged decelerations resulting in delivery of her fetus with Apgar scores of 0, 0, and 5 at 1, 5, and 10 minutes, respectively.

CONCLUSION: Fetal death from intrahepatic cholestasis of pregnancy can be abrupt and not reliably predicted by the characteristics of the fetal heart rate tracing.

© 2009 by The American College of Obstetricians and Gynecologists.

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