Sudden Fetal Death In A Patient With Intrahepatic Cholestasis Of Pregnancy Complicated With Gestational Diabetes Mellitus And Literature Review

Intrahepatic cholestasis of pregnancy (ICP) is a liver disease unique topregnancy, characterized by pruritus，elevated total bile acids level andabnormal liver function tests without other reasons, occurring in the secondhalf of pregnancy. One of the most severe complications of ICP isintrauterine sudden fetal death (IUFD). The mechanism underlying fetaldeath in patients with ICP is still unclear. Gestational diabetes mellitus(GDM) is defined as any degree of glucose intolerance with onset or firstrecognition during pregnancy. And it is well established that GDM isassociated with an increased risk of maternal-fetal morbidity. Wehypothesize that perinatal morbidity and mortality in pregnant womencomplicated with both ICP and GDM may increase. We report a case ofIUFD in a patient with34weeks’ gestation who was retrospectivelydiagnosed with severe ICP. She had a poor previous obstetric history andwas diagnosed to have GDM later in this pregnancy. She was hospitalized for preterm premature rupture of membranes and fetal growth restrictionrevealed by ultrasonography. We analyzed possible causes of the fetal lossand performed a literature review about clinical characteristics of IUFD inpatients with ICP, preventive methods and perinatal outcomes in pregnantwomen complicated with ICP and GDM. In conclusion, we summarizedthree pieces of experience to learn from this case.