DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20184480

Intrahepatic cholestasis of pregnancy: maternal and fetal outcome and its correlation with serum bile acid levels

Bhawna Sharma, Neetu Arora, Kusum Dogra, Kamal S. Negi

Abstract


Background: Maternal, fetal, and neonatal outcomes in parturients with intrahepatic cholestasis of pregnancy (ICP) have been retrospectively documented. We aimed to present pregnancy outcomes of parturients with ICP who underwent delivery. The study was conducted during a 1-year period in a tertiary care centre.

Methods: Data from 1 January to 31 December 2017 were collected to identify parturients with ICP.

Results: Almost 3/4th of births came to a vaginal delivery (76.74%) and only 10 parturients had cesarean delivery. 4 of 10 parturients underwent nonelective cesarean section, while 6 had elective cesarean delivery. 15.15 % vaginal deliveries were instrumental. The most common indications for emergency LSCS and instrumental deliveries was fetal distress followed by failure to progress of labour. Most births occurred at or after 37 weeks of gestation (65%).  Regarding neonatal outcomes in terms of birth weight and Apgar scores at 1 and 5 min, they were positive, as well.  None of the babies had Apgar score < 7 at 5 minutes. No case of perinatal death was observed.

Conclusions: Although the results were generally positive, larger studies need to be conducted to evaluate the maternal and fetal outcomes in ICP and correlation with serum bile acid levels.


Keywords


Fetal outcome, Intrahepatic cholestasis of pregnancy, ICP, Maternal

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References


Dixon PH, Williamson C. The pathophysiology of intahepatic cholestasis of pregnancy. Clin Res Hepatol Gastroenterol 2016;40(2):141-53.

Kamimura K, Abe H, Kawai H, Kamimura H, Kobayashi Y, Nomoto M, et al. Advances in understanding and treating liver disease during pregnancy. World J Gastroenterol. 2015; 21(17):5183-90.

Ahmed KT, Almashhrawi AA, Rahman RN, Hammoud GM, Ibdah JA. Liver diseases in pregnancy: Diseases unique to pregnancy. World J Gastroenterol. 2013;19(43):7639-46.

Goel A, Jamwal KD, Ramachandran A, Balasubramanian KA, Eapen CE. Pregnancy-related liver disorders. J Clin Exp Hepatol, 2014;4(2):151-62.

Bacq Y. Liver diseases unique to pregnancy: a 2010 update. Clin Res Hepatol Gastroenterol 2011;36(3): 182-93.

Biberoglu E, Kirbas A, Daglar K, Kara O, Karabulut E, Yakut HI et al Role of inflammation in intrahepatic cholestasis of pregnancy. J Obstet Gynaecol Res. 2016;42(3):252-7.

Larson SP, Kovilam O, Agrawal DK. Immunological basis in the pathogenesis of intrahepatic cholestasis of pregnancy. Expert Rev Clin Immunol. 2016;12(1):39-48.

Turunen K, Helander K, Mattila Kj, Sumanen M. Intrahepatic cholestasis of pregnancy is common among patients’ first-degree relatives. Acta Obstet Gynecol Scand. 2013;92(9):1108-10.

Marschall HU1, Wikström Shemer E, Ludvigsson JF, Stephansson O. Intrahepatic cholestasis of pregnancy and associated hepatobiliary disease: a population-based cohort study. Hepatology 2013;58(4):1385-91.

Wikström Shemer EA, Stephansson O, Thuresson M, Thorsell M, Ludvigsson JF, Marschall HU. Intrahepatic cholestasis of pregnancy and cancer, immune-mediated and cardiovascular diseases: A population-based cohort study. J Hepatol. 2015;63(2):456-61.

Brouwers L, Koster MP, Page-Christiaens GC, Kemperman H, Boon J, Evers IM 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.

DeLeon A, De Oliveira GS, Kalayil M, Narang S, McCarthy RJ, Wong CA. The incidence of coagulopathy in pregnant patients with ICP: should we delay or avoid neuraxial anaesthesia? J Clin Anesth 2014;26(8):623-7.

Garcia-Flores J1, Cañamares M, Cruceyra M, Garicano A, Espada M, Lopez A et al. Clinical value of maternal bile Acid quantification in intrahepatic cholestasis of pregnancy as an adverse perinatal outcome predictor. Gynecol Obstet Invest. 2015;79(4):222-8.

Glantz A, Marschall HU, Mattsson LA. Intrahepatic cholestasisof pregnancy: relationship between bile acid levels and fetal complication rates. Hepatology 2004;40(2):467-74.