Outpatient versus inpatient follow-up for intrahepatic cholestasis of pregnancy

Aim of the study
The optimum management method and the best time of delivery still remain unclear for intrahepatic cholestasis of pregnancy (ICP). We aimed to ascertain whether there is a benefit of close monitoring at hospital.

Material and methods
We evaluated the maternal and neonatal records of ICPs over a recent five-year period. A total of 35 women and their 38 newborns were analyzed. The impact of hospitalization was evaluated in terms of delivery type, labor induction, preterm delivery, Apgar scores, and neonatal intensive care unit admission.

Results
The median maternal age was 30.7 years, and median gestation at diagnosis was 34 weeks. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were normal in three patients; 32 (91.4%) women had at least one increased hepatic enzyme level. The median AST level was elevated to 66 U/l (almost two-fold), and the median ALT level was 91 U/l (about three-fold). The median gestation time at delivery was 37 weeks. The preterm delivery rate was 45.7%. The median birth weight was 3020 g, and median Apgar scores were 9 and 10 at the 1st and 5th minutes, respectively. Neonatal intensive care unit admission occurred in 21 neonates (55.3%). During pregnancy follow-up, 22 women (62.8%) were hospitalized during their pregnancies. There was no statistically significant difference between groups in terms of obstetric and perinatal outcomes (p > 0.05). However, the hospitalized pregnant women were found to have higher levels of serum transaminases (p = 0.15 and p = 0.01 for ALT and AST, respectively).

Conclusions
Hospitalization may be helpful in some ICP cases, especially when enzyme levels are elevated.