A Study of Intrahepatic Cholestasis of Pregnancy and Its Perinatal Outcome in a Tertiary Care Centre

Abstract

BACKGROUND Intrahepatic cholestasis is one of the unique conditions specific to pregnancy and should be kept in mind when a patient presents with excessive pruritus seen during the late second and early third trimester of pregnancy, causing subtle alterations in liver functions with increased serum bile acids. This study intended to determine the prevalence of obstetric cholestasis in our hospital, its course and pregnancy outcome in these women. METHODS This is a prospective cross sectional study, carried out among the women attending the Department of OBG, Sri Ramachandra medical college. A total of 22 cases were observed to have obstetric cholestasis from those who attended the hospital during the study period. The data about the variables like patient identification details, demographic data, symptoms, laboratory parameters, feto-maternal outcomes were recorded like pre-existing medical conditions, mode of delivery, birth weight, Apgar score at 1 min and 5 mins and admission to NICU were recorded. Data collected were analysed and the data variables were represented appropriately. RESULTS A total of 1813 deliveries were conducted in the study setting during the study period. 1.2 % of cases were observed to have intrahepatic cholestasis. The mean gestational age of onset of obstetric cholestasis was 28 weeks. The mean age of the women considered for the study was 28.5 ± 2.8 years (22-34 years). The mean serum bile acid observed at the time of admission was 33.6 ± 25.2. The mean gestational age at the delivery of the study subjects was 36 W ± 5 days. 50 % of the women had laboured at term and 50 % of the women had preterm labour. 9 women (41 %) delivered through NVD and 13 women (59 %) delivered through lower segment caesarean section. One patient had recurrent cholestasis. The average Apgar score at 1 minute was 7 and at the end of 5 minutes it was 8. 50 % of the children admitted to NICU and 4 women gave the history of admissions into NICU of the babies born even in the previous deliveries, due to varied reasons. No perinatal or maternal mortality was observed during the study period. CONCLUSIONS Intrahepatic cholestasis of pregnancy is common among pregnant women which has an impact on feto-maternal outcomes. It is found to be responsible for a large number of perinatal and neonatal deaths especially after 36 weeks of gestation, but if appropriate antenatal care and timely intervention are implemented outcomes of pregnancy would be better. KEY WORDS Intra hepatic Cholestasis, Pregnancy, Ursodeoxycholic Acid, Pruritus.