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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

doi: 10.1097/AOG.0b013e31818db1c9
Case Reports

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.

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

From the University of Southern California, Los Angeles, California.

Corresponding author: Richard H. Lee, MD, LAC+USC Women’s and Children’s Hospital, 1240 N. Mission Road, Room 5K-40, Los Angeles, CA 90033; e-mail: richarhl@usc.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2009 by The American College of Obstetricians and Gynecologists.