DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20212676

Maternal and perinatal outcome in pregnancy complicated by obstetric cholestasis: study from a tertiary care centre in North India

Deepika Jamwal, Gurpreet Kour, Anil Mehta

Abstract


Background: Intrahepatic cholestasis of pregnancy (IHCP) is the most common pregnancy related liver disorder. It typically presents with troublesome itching and can lead to complications for both mother and foetus. Present study was carried out to study the incidence of Obstetric Cholestasis and its fetomaternal outcome in a tertiary care hospital.

Methods: It was a prospective epidemiological study during a period of one year (May 2020 to April 2021) over 120 pregnant ladies suffering from pruritus and detected as having Obstetric Cholestasis. They were followed up and maternal as well as perinatal outcome recorded. Appropriate statistical analysis done as applicable.

Results: The incidence of Obstetric Cholestasis in our hospital was 9.3%. Majority of cases delivered at term (78.3%). 41.6% patients delivered vaginally, 43.3% had emergency caesarean section, and 2.5% patients had instrumental delivery. Maternal morbidities are due to sleep disturbance (60%), coagulation abnormality (13.3%), increase chance of operative delivery (55.8%) and postpartum haemorrhage (12.5%). Neonatal complications include meconium aspiration (46.6%), NICU admission (36.6%), prematurity (5%) and perinatal mortality (3.3%).

Conclusions: Cholestasis of pregnancy causes maternal pruritus with impaired liver function tests. Maternal morbidity is increased in terms of increased caesarean section rates and discomfort due to pruritus. A timely intervention at 37-38 weeks will reduce the adverse perinatal outcome.

 


Keywords


Intrahepatic cholestasis of pregnancy, Pruritus

Full Text:

PDF

References


Lammert F, Marschall HU, Glantz A, Matern S. Intrahepatic cholestasis of pregnancy: molecular pathogenesis, diagnosis and management. J Hepatol. 2000;33:1012-21.

Beuers U, Pusl T. Intrahepatic cholestasis of pregnancy--a heterogeneous group of pregnancy-related disorders. Hepatol. 2006;43:647-9.

Kenyon AP, Piercy CN, Girling J, Williamson C, Tribe RM, Shennan AH. Obstetric cholestasis, outcome with active management: a series of 70 cases. BJOG. 2002;109:282-8.

Ray A, Tata RJ, Balsara R. Cholestasis of pregnancy. J Obstet Gynecol India. 2005;55:247-50.

Nichols AA. Cholestasis of pregnancy: a review of the evidence. J Perinat Neonatal Nurs. 2005;19:217-25.

Bacq Y, Sapey T, Brechot MC, Pierre F, Fignon A, Dubois F. Intrahepatic cholestasis of pregnancy: a French prospective study. Hepatol. 1997;26:358-364.

Glantz A, Marschall HU, Mattsson LA. Intrahepatic cholestasis of pregnancy: relationships between bile acid levels and fetal complication rates. Hepatol. 2004;40:467-74.

Royal College of Obstetricians and Gynaecologists. Obstetric cholestasis. Green-Top Guideline No 43. 2006. Available at https:// www. rcog. org. uk/en/guidelines-research-services/guidelines/gtg43/. Accessed on 12 February.

Lammert F, Marschall H, Matern S. Intrahepatic cholestasis of pregnancy. Curr Treat Options Gastroenterol. 2003;6:123-32.

Greenes V, Williamson C. Intahepatic cholestasis of pregnancy. World J Gastroenterol. 2009;15(17):2049-66.

Kaur D, Ruchi S. Hepatic disorders in pregnancy. J Obstet Gynaecol India. 2001;51:31-3.

Brouwers L, Koster M, Christiaens PG, Kemperman H, Boon J, Evers I, et al. Intrahepatic cholestasis of pregnancy: maternal and fetal outcomes associated with elevated bile acid levels. Am J Obstet Gynecol. 2015;212(1):100.e1-7.

Shobaili AH, Hamed H, Robaee AA, Alzolibani A, Amin A, Ahmad S. Obstetrical and fetal outcomes of a new management strategy in patients with intra-hepatic cholestasis of pregnancy. Arch Gynecol Obstet. 2010;283(6):1219-25.

Rasheed S, Afghan S, Mazhar SB. Fetomaternal outcome in patients with obstetric cholestasis. Ann. Pak Inst Med Sci. 2009;5(4):211-5.

Alokananda R, Rashne TJ, Roshan B. Nature and outcome of pregnancy in obstetric cholestasis. Obstet Gynecol India. 2005;55(3):247-50.

Ray A, Tata RJ, Balsara R. Cholestasis of pregnancy. J Obstet Gynecol India. 2005;55:247-50.

Dang A, Agarwal N, Bathla S, Sharma N, Balani S. Prevalence of liver disease in pregnancy and its outcome with emphasis on obstetric cholestasis : an Indian scenario. J Obstet Gynecol India. 2010;60(6):413-8.

Kenyon AP, Piercy CN, Girling J, Williamson C, Tribe RM, Shennan AH. Obstetric cholestasis, outcome with active management: a series of 70 cases. BJOG. 2002;109:282-8.

Alsulyman OM, Ouzounian JG, Castro AM, Goodwin TM. Intrahepatic cholestasis of pregnancy: perinatal outcome associated with expectant management. Am J Obstet Gynecol. 1996;175:957-60.

Heinonen S, Kirkinen P. Pregnancy outcome with intrahepatic cholestasis. Obstet Gynecol. 1999;94:189-93.

Rasheed S, Afghan S, Mazhar SB. Fetomaternal outcome in patients with obstetric cholestasis. Ann Pak Inst Med Sci. 2009;5(4):211-5.