Sudden fetal death in a patient with intrahepatic cholestasis of pregnancy complicated with gestational diabetes mellitus

摘要

Intrahepatic cholestasis of pregnancy (ICP) is a liver disease unique to pregnancy, which is characterized by pruritus and abnormal liver function tests (LFTs). It occurs in the second half of pregnancy and resolves quickly after delivery. It is associated with an increased risk of spontaneous preterm delivery, fetal distress and sudden fetal death [1-3]. The cause of ICP and pathophysiology of the fetal complications still remains elusive. Its prevalence varies according to ethnicity and geography. ICP affects 4—10 % of pregnancies in China and the reported incidence of ICP in Chongqing area has risen from 0.32 % in 1986 to 6.0 % in 2004 [4]. This may be attributed to an increased alertness by obstetricians and a better access to bile acids measurement than before. However, in clinical practice, how to prevent fetal death in pregnant women with ICP is one of the biggest challenges to clinicians. A 23-year-old woman at 34 weeks' gestation (WG), gravida 3 para 1, was transferred to our obstetric division at 22:48 on 1 February 2012 for preterm premature rupture of membranes (PPROM). The membranes had already ruptured for over 12 h, and ultrasonography performed in a clinic showed that the fetus was about 5 weeks smaller than gestational age, and fetal growth restriction (FGR) was under suspicion. Prenatal care was performed irregularly during pregnancy.