[7] 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

SGA, small for gestational age. AGA, appropriate for gestational age. CA, chorioamnionitis

In stillbirth associated with ICP, there were evidence of intrauterine fetal distress. The associated peak bile acid values varied significantly, including less than 40 mcmol/L. In two of the three fetal examinations, body cavity fluid, esp., pericardial effusions are present. These could be sign of impending hydrops, an indicator of possible cardiac dysfunction.
Conclusions: This study suggested that maternal bile acid level is not a reliable indicator of potential intrauterine fetal demise. The fetal findings may correlate with one in vitro study that increased fetal serum bile acid level could impair fetal cardiomyocyte function. Our result indicated the importance to study the effects of bile acid on fetal tissue, in addition to current emphasis on placenta.
Category: Autopsy

Wednesday, March 2, 2011 9:30 AM

Poster Session V # 3, Wednesday Morning