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Intrahepatic cholestasis of pregnancy: diagnosis and management; a survey of R oyal A ustralian and N ew Z ealand C ollege of O bstetrics and G ynaecology fellows
Author(s) -
Arthur Chris,
Mahomed Kassam
Publication year - 2014
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/ajo.12178
Subject(s) - medicine , cholestasis of pregnancy , guideline , pregnancy , obstetrics and gynaecology , cholestasis , obstetrics , family medicine , gynecology , fetus , pathology , genetics , biology
Background Intrahepatic cholestasis of pregnancy ( ICP ) is an uncommon obstetric condition characterised by intense maternal pruritis and biochemical abnormality. There is a degree of contention regarding the diagnosis and management of ICP , and currently, there are no nationally accepted guidelines. Aims To conduct a survey of F ellows and M embers of the R oyal A ustralian and N ew Z ealand C ollege of O bstetricians and G ynaecologists ( RANZCOG ) regarding their diagnosis and management ICP . Methods An online survey of currently practising RANZCOG F ellows and M embers, utilising S urvey M onkey. Results Thirty percent of those sent the survey responded, comprising approximately 40% of practising obstetricians. Fasting bile acid and serum transaminase elevation in association with the characteristic itch define the disease process for the majority of respondents and also inform management decisions. There was no critical level of bile acid elevation that mandated treatment for the majority of respondents. Nearly 90% of respondents induce women with ICP at 37–38 completed weeks of pregnancy, due to concerns regarding possible fetal demise. About one‐third of respondents refer to the Royal College of Obstetricians and Gynaecologists ( RCOG ) Green‐top Guideline to advise their decision‐making process, and a similar proportion use local or hospital‐based guidelines. Conclusions Elevated fasting bile acids and abnormal liver function tests define the diagnosis and inform management of ICP by Australian obstetricians. Routine induction of labour for patients with ICP at 37–38 completed weeks of pregnancy is widely practised in Australia. An evidence‐based guideline would assist clinicians who manage such cases in Australia.