Cholestasis of pregnancy: effects on maternal and fetal outcome

Abstract

Background: Intrahepatic cholestasis of pregnancy (ICP) typically occurs in late pregnancy affecting 1.5-2% pregnancies. Limited data is available regarding its fetal and maternal implications. This study aims to assess the impact of ICP on maternal and fetal outcome.Methods: A total 200 patients with pruritus in later half of pregnancy were studied over a period of 18 months out of which 135 were diagnosed as ICP. Clinical and biochemical parameters like serum aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total protein, and gamma glutamyl transferase was recorded. Maternal and fetal outcome was noted in the form of LSCS rate, preterm births, fetal distress and neonatal ICU admissions.Results: In this study, most common symptom was pruritus. Most of cases had onset of symptoms between 32-36 weeks. High LSCS rates were seen among cases. Intrapartum complications viz. meconium staining of amniotic fluid (57.8%), preterm delivery (11.9%), fetal distress (42.2%) were significantly higher in study population and there was high incidence of NICU admissions (49. 6% neonates) among cases mostly due to meconium aspiration and prematurity.Conclusions: ICP increases maternal morbidity and is associated with adverse perinatal outcome viz. increased risk of fetal distress, preterm births and sudden IUD at term as evidenced in this study. A timely intervention at 37-38 weeks will reduce the adverse outcomes.

Estimation of serum bile acid level for diagnosis of intrahepatic cholestasis of pregnancy, and its correlation with maternal and fetal outcome

“…Our findings were similar to study conducted by Hassan N et al (2020). 9 This was in contrast to the study conducted by Sharma et al (2018) 10 where no significant difference was observed between liver function test parameters and serum bile acid with the mode of delivery.…”

“…Garcia-Flores et al (2015) 13 conducted a prospective observational study in 145 pregnant patients with persistent pruritus and concluded that IHCP patients had higher rate of NICU admission and overall neonatal morbidity. According to Hassan et al (2020) 9 a high occurrence of NICU admissions (49.6% versus 15.4%) was observed in abnormal serum bile acid than the controls (p < 0.05).…”

Placental Abruption and Partial Placental Prolapse During Induction of Labor in a 31-Year-Old Female With Intrahepatic Cholestasis of Pregnancy: A Case Report

“…In both women with ICP and those without, IOL may be associated with various complications. However, in women with ICP, timely intervention at 37-38 gestational weeks will reduce adverse outcomes for the mother and the baby [ 20 ].…”

Maternal and fetal outcomes in pregnancies complicated with intrahepatic cholestasis of pregnancy

“…Though, maternal consequences of ICP are benign; however, clear association is seen amongst ICP and higher prevalence of fetal distress, pretmature delivery, and sudden intrauterine demise. Most common symptom was pruritus and most of the patients developed pruritus between 32weeks to 36 weeks period of gestation [12] . In this study, most of the women had delivery at term which contrasted with the study by Senocak et al, [13] most of the women delivered at ≤37 weeks' gestation.…”