Antepartum fetal cerebral hemorrhage not predicted by current surveillance methods in cholestasis of pregnancy

BACKGROUND: The reason for increased fetal mortality in cholestasis of pregnancy is not completely understood. Intracerebral hemorrhage due to coagulation disorders, similar to those reported in the mother, is a possible explanation. CASE: Antepartum fetal death occurred at 37 weeks in a primigravida with cholestasis of pregnancy. The woman was taking no medication. Autopsy revealed extensive cerebral hemorrhage. A cardiotocogram and biophysical profile performed 24 hours and 5 days, respectively, before fetal death had been normal. CONCLUSION: Antepartum fetal death may occur in patients with mild cholestasis who are taking no medication. Intracerebral hemorrhage is a possible cause, and this may be unpredictable with current methods of fetal surveillance. This possibility constitutes an argument in support of delivering these pregnancies as soon as lung maturity is achieved.