Patient Safety and Quality

We have a policy on Cholestasis of Pregnancy that may be somewhat too conservative:
a) hospitalization for continuous fetal monitoring  in all patients with bile acids of > 40,  or high LFT's
b) outpatient monitoring only for mild cases, i.e. bile acids < 40
c) hospitalization for all patients after 36 weeks with pruritus until COP is ruled out
d) delivery of any patients with pruritus at GA > 38.0 weeks, without need for confirmation with BA / LFT's

Could you share your local policy / guideline?  Thanks in advance

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Georges Sylvestre
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The hospitals where I practice do not have a policy on management of cholestasis.
Our local MFM practice does not have a policy either.
Per several articles reviewed in UpToDate, risk of IUFD is about 1.5% with bile acids 40-99 micromol/L, so hospitalization and continuous monitoring are aggressive.
I generally monitor with NST twice weekly and deliver by 37 wks, earlier with severe or progress lab findings despite treatment.
But I am well aware that there is no direct evidence to demonstrate benefit of this versus any other management strategy.
The foregoing statements reflect personal opinions, not the opinion of SMFM or the Patient Safety and Quality Committee.

Regards,
Andrew Combs MD
San Jose, CA


Original Message------

We have a policy on Cholestasis of Pregnancy that may be somewhat too conservative:
a) hospitalization for continuous fetal monitoring  in all patients with bile acids of > 40,  or high LFT's
b) outpatient monitoring only for mild cases, i.e. bile acids < 40
c) hospitalization for all patients after 36 weeks with pruritus until COP is ruled out
d) delivery of any patients with pruritus at GA > 38.0 weeks, without need for confirmation with BA / LFT's

Could you share your local policy / guideline?  Thanks in advance

------------------------------
Georges Sylvestre
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Jeff Wright
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Original Message:
Sent: 09-11-2018 17:44
From: Georges Sylvestre
Subject: cholestasis of pregnancy

We have a policy on Cholestasis of Pregnancy that may be somewhat too conservative:
a) hospitalization for continuous fetal monitoring  in all patients with bile acids of > 40,  or high LFT's
b) outpatient monitoring only for mild cases, i.e. bile acids < 40
c) hospitalization for all patients after 36 weeks with pruritus until COP is ruled out
d) delivery of any patients with pruritus at GA > 38.0 weeks, without need for confirmation with BA / LFT's

Could you share your local policy / guideline?  Thanks in advance

------------------------------
Georges Sylvestre
------------------------------