Perinatal outcomes and intrahepatic cholestasis of pregnancy: a prospective study

Sangeeta Parihar, Swatantar Singh


Background: Women with intrahepatic cholestasis of pregnancy (ICP) have an increased risk for postpartum haemorrhage, dyslipidaemia, preterm labour and operative interference. Fetus in ICP has been associated with an increased incidence of preterm labour, preterm prelabour rupture of membrane, fetal distress, abnormal CTG, meconium staining, spontaneous intrauterine death. The present study was done to evaluate the perinatal outcomes – maternal outcomes and fetal outcomes of ICP.

Methods: This was a prospective observational study carried out in a tertiary care teaching hospital. Total 1100 pregnant women were screened during the study period. Patients with ICP were identified in maternity care units after eliciting history about itching. Pregnancies with pregnancy induced hypertension and other liver diseases in pregnancy were excluded.

Results: 62 pregnant women with prevalence rate of 5.64% have been found to be suffering from ICP. The most frequently affected (22, 35.48%) age-group with ICP were belong to age > 35 years. A majority of pregnant women with intrahepatic cholestasis of pregnancy was of multipara. ICP was highly significantly associated with small for gestational age (SGA, p-value: 0.0003); abnormal cardiotocography (CTG, p-value: 0.0002); and meconium stained liquor (p-value: 0.0001). Caesarean section as mode of delivery found significantly associated (p-value: 0.0033) with ICP. Insomnia (p-value: 0.0045); dyslipidemia (p-value: 0.0011); and postpartum haemorrhage (p-value: 0.0122) were also found significantly with ICP.

Conclusions: ICP can adversely affect fetal as well as maternal pregnancy outcomes. Maternal outcomes have good prognosis, but fetal outcomes can be improved by timely and effective intervention.


Adverse perinatal outcomes, Fetal outcomes, Intrahepatic cholestasis of pregnancy, Maternal outcomes

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Soma-Pillay P, Nelson-Piercy C, Tolppanen H, Mebazaa A. Physiological changes in pregnancy. Cardiovasc J Afr. 2016;27(2):89-94.

Wolf JL. Liver disease in pregnancy. Med Clin North Am. 1996;80(5):1167-87.

Goel A, Jamwal KD, Ramachandran A, Balasubramanian KA, Eapen CE. Pregnancy-related liver disorders. J Clin Exp Hepatol. 2013;4(2):151-62.

Pusl T, Beuers U. Intrahepatic cholestasis of pregnancy. Orphanet J Rare Dis. 2007;2(1):26.

Ghosh S, Chaudhuri S. Intra-hepatic Cholestasis of Pregnancy: A Comprehensive Review. Indian J Dermatol. 2013;58(4):327.

Svanborg A. A study of recurrent jaundice in pregnancy. Acta Obstet Gynecol Scand. 1954;33(4):434-44.

Thorling L. Jaundice in pregnancy; a clinical study. Acta Med Scand Suppl. 1955;302:1-123.

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

Schorr-Lesnick B, Lebovics E, Dworkin B, Rosenthal WS. Liver diseases unique to pregnancy. Am J Gastroenterol. 1991;86(6):659-70.

Reyes H. The enigma of intrahepatic cholestasis of pregnancy: lessons from Chile. Hepatology. 1982;2(1):87-96.

Reyes H, Simon FR. Intrahepatic cholestasis of pregnancy: an estrogen-related disease. Semin Liver Dis. 1993;13(3):289-301.

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(3):282-8.

Ray A, Tata RJ, Balsara R. Cholestasis of pregnancy. J Obstet Gynecol India. 2005;55(3):247-50.

Nguyen KD, Sundaram V, Ayoub WS. Atypical causes of cholestasis. World J Gastroenterol. 2014;20(28):9418-26.

Floreani A. Hepatitis C and pregnancy. World J Gastroenterol. 2013;19(40):6714-20.

Riely CA, Bacq Y. Intrahepatic cholestasis of pregnancy. Clin Liver Dis. 2004,8(1):167-76.

Steven MM. Pregnancy and liver disease. Gut.1981;22(7):592-614.

Knox TA, Olans LB. Liver disease in pregnancy. N Engl J Med. 1996;335(8):569-76.

Saleh MM, Abdo KR. Consensus on the management of obstetric cholestasis: National UK survey. BJOG. 2007;114(1):99-103.

Mays JK. The active management of intrahepatic cholestasis of pregnancy. Curr Opinion Obstet Gynecol. 2010;22(2):100-3.

Nichols AA. Cholestasis of Pregnancy: A Review of the Evidence. J Perinat Neonatal Nurs. 2005;19(3):217-25.

Saleh MM, Abdo KR. Consensus on the management of obstetric cholestasis: National UK survey. BJOG. 2007;114(1):99-103.

Heinonen S, Kirkinen P. Pregnancy outcome with intrahepatic cholestasis. Obstet Gynecol. 1999;94(2):189-93.

Gardiner FW, McCuaig R, Arthur C, Carins T, Morton A, Laurie J, et al. The prevalence and pregnancy outcomes of intrahepatic cholestasis of pregnancy: A retrospective clinical audit review. Obstetric Medicine. 2018:1753495X18797749.

Guntupalli SR, Steingrub J. Hepatic disease and pregnancy: An overview of diagnosis and management. Crit Care Med 2005;33(10):S332-9.

Paternoster DM, Fabris F, Palu G, Santarossa C, Bracciante R, Snijders S. Intra-hepatic cholestasis of pregnancy in hepatitis C virus infection. Acta Obstet Gynecol Scand 2002;81(2):99-103.

Glantz A, Marschall HU, Mattsson LA. Intrahepatic cholestasis of pregnancy: Relationships between bile acid levels and fetal complication rates. Hepatology 2004;40(2):467-474.

Medda S, Sengupta S, Palo U. A study of the outcome of pregnancy complicated by obstetric cholestasis. Int J Reprod Contracept Obstet Gynecol. 2018;7(3):996-1001.

Johnston WG, Baskett TF. Obstetric cholestasis. A 14-year review. Am J Obstet Gynecol. 1979;133(3):299–301.

Reid R, Ivey KJ, Rencoret RH, Storey B. Fetal complications of obstetric cholestasis. Br Med J. 1976;1(6014):870–2.

Rioseco AJ, Ivankovic MB, Manzur A, Hamed F, Kato SR, Parer JT, et al. Intrahepatic cholestasis of pregnancy: a retrospective case-control study of perinatal outcome. Am J Obstet Gynecol. 1994;170(3):890-5.

Lunzer M, Barnes P, Byth K, O'Halloran M. Serum bile acid concentrations during pregnancy and their relationship to obstetric cholestasis. Gastroenterology. 1986;91(4):825-9.

Laatikainen T, Ikonen E. Fetal prognosis in obstetric hepatosis. Ann Chir Gynaecol Fenn. 1975;64(3):155-64.

Shaw D, Frohlich J, Wittmann BA, Willms M. A prospective study of 18 patients with cholestasis of pregnancy. Am J Obstet Gynecol. 1982;142(6):621-5.