At what gestational age should be pregnancy with cholestasis of pregnancy be terminated?

Ans. is c, i.e. 38 weeksRef. COGDT 10/e, p 382; Williams Obs 24/e. p 1085, Mgt of High Risk pregnancy--S S Trivedi Manju Pun, p 357.Management of Intrahepatic Cholestasis - Medical ManagementThe most troublesome feature of intrahepatic cholestasis is pruritis (and pruritis is due to bile acid in blood):Pruritis can be managed temporarily with antihistaminics and topical emollientsUrsodeoxychotic acid (10-15 mg/kg/d in 2 divided doses) relieves pruritis decreasing the concentration of bile acid in blood and it also improves biochemical abnormalities."ACOG (2006) has concluded that ursodeoxycholic acid both alleviates pruritis and improves fetal outcomes, although evidence for the latter is not compelling." --Williams Obs 24/e, p 1085As far as cholestyramine is concerned."Cholestyramine is no longer routinely used because of poor compliance" --COGDT 10/e, p 382"Cholestyramine may be effective in 50-70% of women. This compound also causes further decreased absorption of fat soluble vitamins, which may lead to vitamin K deficiency, fetal coagulopathy may develop and there are reports of intracranial hemorrhage and still births." --Williams Obs 24/e, p 1085Corticosteroids:"Cholestyramine is no longer routinely used because of poor compliance" --COGDT 10/e, p 382"Dexamethasone in a dose of 12 mg/d for 1 week, improves biochemical abnormalities but does not improve pruritis however it is less effective as compared to USCA." --Management of High Risk Pregnancy, S S Trivedi Manju Puri, 1/e, p 357Corticosteroids:Antihistaminics relieve pruritis and have no effect on biochemical abnormally temporarily, (hence they are not DOC (only provide symptomatic relief).Obstetric management--Mgt of High Risk Pregnancy--S S Trivedi Manju Puri, p 358In patients of intrahepatic cholestasis of pregnancy - there is increased perinatal mortality. Hence fetal surveillance is done with biweekly NST. Conventional antepartum testing, does not predict fetal mortality as there is sudden death in cholestasis due to acute hypoxia, hence delivery is recommended at 37-38 weeks. In those patients with jaundice (S bilirubin >1.8mg%) termination of pregnancy should be done at 36 weeks.