Cholestasis of pregnancy: a prospective analysis from a South Andaman teaching hospital

Abstract

Background: Intrahepatic cholestasis of pregnancy (IHCP) is one of the commonest pregnancy related liver disorder. Although the maternal course is usually benign, there is an increased risk of spontaneous preterm delivery, fetal compromise, meconium stained amniotic fluid and even intrauterine fetal demise. The objective of this study was to study the incidence of IHCP and its impact on maternal and perinatal outcome.Methods: A prospective study carried out in 68 number of IHCP cases. Diagnosis was done on the basis of clinical and laboratory parameters. All the cases were followed up to the puerperium to find out maternal and perinatal outcome.Results: The incidence of cholestasis of pregnancy was 2.73%. Most (88%) of the cases were presented with generalized pruritus, relived with ursodeoxycholic acid and complete recovery was observed after delivery. The rate of instrumental delivery was 8.82% and caesarean section rate was 30.88%. Most common indication of caesarean section was fetal distress and non-progress of labour. There was one stillbirth at 35 weeks however none of the mother had complication during labour or puerperal period.Conclusions: Increased level of liver enzymes in patients of IHCP associated with poor perinatal outcome. Therefore, careful monitoring during antenatal period and termination of pregnancy at term will result in favourable outcome of both mother and baby.

A Study on Intrahepatic Cholestasis in Pregnancy to Evaluate Risk factors for Adverse Perinatal Outcome: An Experience from a Tertiary Care Center of East India

“…Mean gestational age was 36.11 ± 2.75 weeks in the pregnancy which is complicated by IHC within the study group. Mean age of 37 and 38 weeks was reported by Pegu et al [1] and Arthuis et al [14] in their similar study.…”

“…Pathogenesis of IHC is thought to be multifactorial, mostly depending on genetic configuration, geographical area, environmental changes, and ethnicity. In the present study, there [1] Rook et al, [3] and Pokhrel et al [4] who were found that 2.73%, 1.9%, and 1.15%, respectively, in their study population.…”

“…[3,4,5,7] In India, it's prevalence of 1-5% is reported from different studies, the variations are mostly due to relevant geographical variation of incidence. [1,6] Maternal treatment with ursodeoxycholic acid (UDCA) and Vitamin K is the only available treatment option. [9] Treatment with UDCA may cause significant relief of pruritus and improved biochemical parameters.…”

“…[9] Treatment with UDCA may cause significant relief of pruritus and improved biochemical parameters. Due to possibilities of adverse pregnancy outcome, several authors advocated for termination of pregnancy at 38 weeks or before, [1] depending on raised bile acid levels.…”

“…Intrahepatic cholestasis (IHC) is the most common hepatic disorder during pregnancy. [1] It is reversible disorder, characterized by intense pruritus that involves whole body including palm and sole, with consequent sleep deprivation. [2] IHC usually is found at the second or third trimester of pregnancy along with abnormally high serum aminotransferases and/or raised bile acid level.…”