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Master Thesis

Issues périnatales en cas de cholestase gravidique : étude rétrospective au sein de la maternité de Port-Royal

Abstract : Background: to this day, no national guidelines on the management of intrahepatic cholestasis of pregnancy have been published even though it is the most frequent liver disease occurring during pregnancy. The major risk of this disease seems to be induced prematurity, but few studies have evaluated this risk in the context of non-systematic premature induced labor. Objectives: to compare the terms of delivery between women with cholestasis and women with no cholestasis of pregnancy. The secondary objectives were to identify the factors associated with the occurrence of cholestasis, to compare the delivery routes and neonatal outcomes between women with and without cholestasis of pregnancy and to compare the delivery routes and neonatal outcomes depending on the biliary acid rate in patients with cholestasis of pregnancy. Method: we conducted an exposed versus unexposed retrospective cohort study including all women who delivered between January 1st, 2012 and September 30th, 2018 in the Port-Royal maternity unit. Women with cholestasis of pregnancy composed the exposed group and the women with no cholestasis composed the unexposed group. The primary outcome was the term at delivery. Secondary outcomes were mode of delivery, neonatal outcome, and mode of onset of labor.Results: among the 33,939 women included, 252 (0.7%) had a cholestasis of pregnancy. Multiple pregnancy, gestational diabetes, and preeclampsia were factors associated with cholestasis of pregnancy. Prematurity (27.4% versus 11.2%, p < 0.05 ), caesarean section (38.4% versus 25.1%, p < 0.05) and induction of labor (59.1% versus 21%, p < 0.05) were significantly more frequent in the group of cholestasis of pregnancy compared to no cholestasis. A 5-minute Apgar score below 7 was significantly more frequent in the group of cholestasis of pregnancy: 7.1% versus 3.8% (p = 0.005). The rate of neonatal resuscitation at birth was significantly higher in the group of cholestasis of pregnancy: 17.1% versus 6.7% (p < 0.05). Prematurity was significantly more frequent when the rate of biliary acid was = 40µmol/L compared to < 40 µmol/L: 41.8% versus 23.4% (p = 0.007). Conclusion: the obstetrical and neonatal outcomes seem to be less favorable in women with cholestasis of pregnancy. It seems important to inform patients about the risk of prematurity when a diagnosis of cholestasis of pregnancy has been made.
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Léa Bourdignon. Issues périnatales en cas de cholestase gravidique : étude rétrospective au sein de la maternité de Port-Royal. Gynécologie et obstétrique. 2020. ⟨dumas-03049081⟩

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