ABSTRACT
COMPLICATIONS (WITHOUT TREATMENT) Spontaneous preterm birth (SPTB) 15%, meconium 45%, nonreassuring fetal heart testing (NRFHT) 5% to 15%, fetal death 2% to 10%, neonatal death 1% to 2%, and postpartum hemorrhage 20% to 22%. SPTB occurs mostly at 32 to 36 weeks, as for other SPTB. Fetal deaths occur mostly 37 weeks (3). Etiology of fetal deaths is unclear, but taurocholate is toxic to cardiomyocytes (11). Complications occur almost only in severe cases. No increase in perinatal deaths has occurred in recent series with treatment and delivery by 37 to 38 weeks (2,12). Subclinical steatorrhea may occur along with fat malabsorption, and this may lead to vitamin K deficiency, resulting in a prolonged prothrombin time and postpartum hemorrhage (7).
PREGNANCY CONSIDERATIONS Up to 50% of women recall pruritus during pregnancy, but few have elevated bile acids. Bile acids may be normal at first, and increase later (usually increase an average of 3 weeks after symptoms of pruritus). Of ICP diagnoses, 80% to 86% are made after 30 weeks.
