A study of the outcome of pregnancy complicated by obstetric cholestasis
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20180880Keywords:
Epidemiological study, Obstetric cholestasis, OutcomeAbstract
Background: Obstetric cholestasis is one of the most common causes of liver disease in pregnancy. Present study was carried out to study the incidence of Obstetric Cholestasis and its feto-maternal outcome in a tertiary care hospital.
Methods: It is a prospective epidemiologycal study during a period of one year (2014 to 2015) over 100 pregnant ladies suffering from pruritus and detected as having Obstetric Cholestasis. They were followed up and maternal as well as fetal-neonatal outcome recorded. Appropriate statistical analysis done as applicable.
Results: The incidence of Obstetric Cholestasis in our hospital was 9.9%. Majority of cases (43.0%) are diagnosed in late gestational age, mostly during 28 to 32 weeks period of gestation. Maternal morbidities are due to sleep disturbance (60/100), dyslipidemia, coagulation abnormality, PPH (10.0%) and increase chance of operative delivery (66.0%). Neonatal morbidities are mainly due to fetal distress, prematurity (22.0%), low birth weight (32/100) and meconium staining of amniotic fluid (42.0%). Maximum number of patients are delivered at 37 to 38 weeks, due to active and early intervention.
Conclusions: Early diagnosis and active maternal and fetal surveillance is of utmost importance to avoid adverse outcomes.
Metrics
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. Hepatology. 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.
Greenes V, Williamson C. Intahepatic cholestasis of pregnancy. World J Gastroenterol. 2009;15(17):2049-66.
Nichols AA. Cholestasis of Pregnancy: A Review of the Evidence. J Perinat Neonatal Nurs. 2005;19:217-25.
Saleh MM, Abdo KR. Consensus on the management of obstetric cholestasis: National UK survey. BJOG. 2007;114:99-103.
Mays JK. The active management of intrahepatic cholestasis of pregnancy. Curr Opinion Obstet Gynecol. 2010;22:100-3.
Bacq Y, Sapey T, Brechot MC, Pierre F, Fignon A, Dubois F. Intrahepatic cholestasis of pregnancy: a French prospective study. Hepatology. 1997;26:358-364.
Gonzalez MC, Reyes H, Arrese M, Figueroa D, Lorca B, Andresen M et al. Intrahepatic cholestasis of pregnancy in twin pregnancies. J Hepatol. 1989;9:84-90.
Glantz A, Marschall HU, Mattsson LA. Intrahepatic cholestasis of pregnancy: Relationships between bile acid levels and fetal complication rates. Hepatology. 2004;40:467-74.
Royal College of Obstetricians and Gynaecologists. Obstetric cholestasis. Green-Top Guideline No 43. 2006.
Lammert F, Marschall H, Matern S. Intrahepatic cholestasis of pregnancy. Curr Treat Options Gastroenterol. 2003;6:123-32.
Ahlfeld F. Reports and work from the obstetrics gynecological clinic in Giessen 1881-1882. Leipzig, Grunow FW;1883:148.
Abedin P, Weaver JB, Eggintin E. Intrahepatic cholestasis of pregnancy: prevalence and ethnic distribution. Ethnic Health. 1999;4:35-7.
Reyes H. Review: intrahepatic cholestasis. A puzzling disorder of pregnancy. J Gastroenterol Hepatol. 1997;12:211-6.
Germain AM, Carvajal JA, Glasinovic JC, Kato S, Williamson C. Intrahepatic cholestasis of pregnancy: an intriguing pregnancy-specific disorder. J Soc Gynecol Investig. 2002;9:10-14.
Gupta A, Kakkar T, Gupta Y, Hak J. Cholestasis of pregnancy. J Obstet Gynecol India. 2009 July/August;59(4):320-3.
Padmaja M, Pal B, Gupta JK, Ramamurthy S, Chaudhury M. A study of obstetric cholestasis. J Obstet Gynaecol India. 2010;60(3):225-31.
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.
Sosa SY, Valenzuela A, Pacheco J, Damián R. Intrahepatic Cholestasis of Pregnancy: Evaluation of Risk Factors and Predictive Factors. Internet J Gynecol Obstet. 2010;12(2):465-74.
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.
Deveer R, Engin-Ustun Y, Celen S, Eryilmaz OG, Tonguc E, Mollamahmutoglu L et al. Two-year experience of obstetric cholestasis: outcome and management. Clin Exp Obstet Gynecol. 2011;38(3):256-9.
Dann AT, Kenyon AP, Wierzbicki AS, Seed PT, Shennan AH, Tribe RM. Plasma lipid profiles of women with intrahepatic cholestasis of pregnancy. Obstet Gynecol. 2006;107:106-114.
Roncaglia N, Arreghini A, Locatelli A, Bellilni P, Andreotti C, Ghidini A. Obstetric cholestasis: outcome with active management. Eur J Obstet Gynecol Reprod Biol. 2002;100:167-70.
Fisk NM, Storey GNB. Fetal outcome in obstetric cholestasis. Br J Obstet Gynaecol. 1988;95:1137-43.
Alsulyman OM, Ouzounian JG, Ames Castro M, Goodwin TM. Intrahepatic cholestasis of pregnancy: perinatal outcome associated with expectant management. Am J Obstet Gynecol. 1996;175:957-60.
Williamson C, Hems LM, Goulis DG, Walker I, Chambers J, Donaldson O et al. Clinical outcome in a series of cases of obstetric cholestasis identified via a patient support group. BJOG. 2004;111:676-81.
Downloads
Published
How to Cite
Issue
Section
