Fetal & Placental Findings in Stillbirth Associated with Pregnancies Complicated by Intrahepatic Cholestasis.
Mai He, Stefan Kostadinov, Halit Pinar. Women & Infants Hospital/Brown University Medical School, Providence, RI
Background: Intrahepatic cholestasis of pregnancy (ICP) is a condition associated with high rate of unpredictable stillbirth. The pathogenesis of IUFD is poorly understood and there is no data on postmortem examination in the literature. Here, we present clinical, laboratory and histopathological data on a single-institution series of stillbirth associated with ICP.
Design: This is a retrospective study by searching the archives for postmortem examinations from October 2006 to September 2010 with keyword “cholestasis”. Clinical information including prenatal history, maternal peak bile acid level, medications, and postmortem examination findings were extracted from the Hospital Health Information System.
Results: Eighty cases of ICP were identified with 4 with stillbirth (4/80, 5%). Clinical information and pathology findings are summarized in table 1:
|Case No.||Gestational Age (wks)||OB & Prenatal History||Peak Bile Acid Level (mcmol/L)||Placental findings||Fetal gender||Postmortem findings|
|1||30||G5P0404, cholecystectomy, pruritus. On Delalutin & Ursodiol||175||SGA, meconium, erythroblastosis, uneven villous maturity||M||LGA, perinatal stress|
|2||38||G5P0202, incompetent cervix, nephrolithiasis, cholecystectomy. On Delalutin||109||SGA, meconium, acute CA||F||Perinatal stress, grade I maceration, body cavity fluid including pericardial effusions|
|3||36.5||G1P0, on Ursodiol||109||AGA, meconium, Intervillous thrombi||M||Perinatal stress, body cavity fluid including pericardial effusions, hepatomegaly|
|4||38||G3P0020, generalized pruritus||28||AGA, meconium, acute subchorionitis, villous edema and Tenney-Parker changes||N/A||N/A|