Evaluation of fetal aortic isthmus diameter and flow in pregnant women with intrahepatic cholestasis of pregnancy; may it be a marker of poor perinatal outcomes?

Abstract

Aim

To evaluate the fetal aortic isthmus (AoI) diameter and flow in pregnant women diagnosed with intrahepatic cholestasis of pregnancy (ICP).

Methods

In this prospective case–control study, fetal AoI diameter and Doppler measurements were performed in the ICP group (n: 30) and the control group (n: 42). Clinical characteristics, fetal AoI diameter and Doppler measurements, serum bile acid levels, liver enzyme levels, and obstetric and perinatal outcomes were compared between the groups.

Results

The AoI diameter was 4.8 ± 0.95 mm in the ICP group and 4.2 ± 0.62 mm in the control group, indicating a statistically significant difference (p = 0.003). The AoI Doppler flow parameters did not significantly differ between the groups (p > 0.05). When evaluated in subgroups according to disease severity, the AoI diameter and Doppler measurements did not significantly differ between the mild and severe ICP cases (p > 0.05). The AoI diameter was significantly larger in those requiring admission to the neonatal intensive care unit (NICU) (p = 0.005). This diameter was also larger in patients with fetal distress, albeit with no statistically significant difference (p = 0.65).

Conclusions

ICP is a pathology with known adverse fetal cardiac effects, but there is no effective method to predict adverse perinatal outcomes. The enlarged AoI diameter in the fetuses of mothers with ICP and the association of this enlargement with NICU requirements are important findings of this study. Further research with a larger number of patients is necessary to evaluate the clinical utility of fetal AoI diameter and Doppler parameters in ICP.