Photo Credit: Elena Pimukova

The following is a summary of the “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?,” published in the January 2025 issue of The Journal Obstetrics and Gynecology Research by Başaran et al.

This study aimed to assess fetal aortic isthmus (AoI) diameter and Doppler flow characteristics in pregnancies complicated by intrahepatic cholestasis of pregnancy (ICP), a disorder known to be associated with adverse fetal cardiovascular effects. In this prospective case-control study, fetal AoI measurements were obtained from 30 pregnant women diagnosed with ICP and compared with those from 42 healthy controls. Clinical characteristics, fetal AoI diameter and Doppler parameters, serum bile acid levels, liver enzyme levels, and obstetric and perinatal outcomes were analyzed between the groups. 

The mean AoI diameter was significantly larger in the ICP group (4.8 ± 0.95 mm) compared to the control group (4.2 ± 0.62 mm; P= 0.003), suggesting a potential impact of ICP on fetal vascular development. However, no statistically significant differences were observed in AoI Doppler flow parameters between the groups (P> 0.05). When stratified by disease severity, neither AoI diameter nor Doppler measurements showed significant variation between mild and severe ICP cases (P> 0.05). Notably, fetuses requiring admission to the neonatal intensive care unit (NICU) had significantly larger AoI diameters (P= 0.005), indicating a possible association between AoI enlargement and adverse neonatal outcomes. 

Additionally, an increased AoI diameter was observed in fetuses experiencing distress, although the difference did not reach statistical significance (P= 0.65). While ICP is recognized for its detrimental effects on fetal cardiac function, no reliable predictors for adverse perinatal outcomes currently exist. The findings of this study suggest that AoI enlargement may serve as a potential indicator of neonatal risk in ICP-affected pregnancies. However, further research with larger cohorts is required to validate the clinical utility of fetal AoI diameter and Doppler assessments as predictive tools for perinatal complications in ICP.

Source: obgyn.onlinelibrary.wiley.com/doi/10.1111/jog.16222