§ Dr. Lynne JonesTo ask the Secretary of State for Health (1) what is the exact source of the information given in her answer of 8 July 1994,Official Report, column 366, that (a) obstetric cholestasis affects one in 1,000 pregnancies and (b) in her letter of 23 August 1994 to the right hon. Member for Sutton Coldfield (Sir N. Fowler) that parental mortality in mothers affected by obstetric cholestasis is five times higher than normal;
(2) if she will make it her policy to encourage epidemiological studies to ascertain the incidence of stillbirth due to obstetric cholestasis;
(3) what information she has on the cause of the stillbirths referred to in her answer of 22 June 1994, Official Report, column 198; and what action she is taking to improve that information.
§ Mr. SackvilleInformation is available in the following articles;
Reyes H. the Spectrum of Liver and Gastrointestinal Disease seen in Cholestatis of Pregnancy Gastroenterol Clin North Am 1992 21 905–11, Schorr-Lesnick B. et al Liver Diseases Unique to Pregnancy Am Journal Gastroenterol 1991; 86: 659–62 and de Swiet M. ed Medical Disorders in Obstetric Practice Oxford: Blackwell Scientific 1984.Copies of the articles will be placed in the Library. The figure of one in 1,000 pregnancies is an estimate based on the published sources above and was intended to indicate the order of magnitude of the condition.
Health authorities already participate in epidemiological surveys to establish the causes of stillbirths and infant deaths and in the "Confidential Enquiry into Stillbirths and Deaths in Infancy"— CESDI—which was established in 1992. This is the mechanism that is in place for identifying avoidable factors that give rise to stillbirths and deaths in infancy. CESDI's second annual report for 1993, which is due to be published shortly, includes examination of the small proportion of stillbirths which are associated with delivery. Its future work programme is being widened to include other stillbirths.
Although the cause of most stillbirths are unknown, a large proportion are due to fetal conditions such as asphyxia at birth, congenital anomalies and prematurity, while others are the result of maternal conditions such as hypertension and haemorrhage.