Early induction of labor in high-risk intrahepatic cholestasis of pregnancy: what are the costs?

Purpose Induction of labor among pregnant women with high levels of total bile acid (TBA) is common among clinicians. We examined, if women with intrahepatic cholestasis of pregnancy (ICP) and TBA ≥ 40 μmol/l have a higher risk of maternal–fetal complications, when labor is induced at 37 weeks of gestation, compared with induction of labor at term in women with low-risk ICP. Methods Retrospective cohort study of 16,185 women delivering at Roskilde University Hospital in the period 2006–2011. Women with high-risk ICP (TBA ≥ 40 μmol/l) had labor induced at 37 weeks of gestation; women with low-risk ICP (TBA < 40 μmol/l) at term. Outcomes Mode of delivery, duration of induction procedures, highest level of TBA and alanine aminotransferase (ALT) and for the neonates: Apgar scores at 5 min, umbilical cord pHs and SBEs, NICU admissions and birthweights. Results The incidences of ICP was 1.2 % (95 % CI 1.05–1.39 %) altogether and for high-risk ICP 0.4 % (95 % CI 0.27–0.46 %). No difference was found in mode of delivery, length of induction of labor nor in neonatal outcomes, except for an expected difference in birthweight. In high-risk ICP, ALT was not raised in 10.3 % (95 % CI 2.5–18.2 %). Conclusion Early induction of labor at 37 weeks of gestation seems justified in high-risk ICP, as, except for abbreviating gestational age by 9 days with 296 g smaller babies, induction of labor was not followed by detectable maternal–fetal disadvantages and is favored by an expected major reduction in ICP stillbirth risk.