A study on feto-maternal outcome of intra hepatic cholestasis of pregnancy
Keywords:Antenatal care, Intrahepatic cholestasis of pregnancy, Obstetric choloestasis
Background: Intrahepatic cholestasis of pregnancy is one kind of the hepatic disorder which is unique to pregnancy. It is associated with many adverse pregnancy outcomes if doesn’t intervened at right time. It requires adequate clinico-biochemical correlation during management.
Methods: A prospective observational study was conducted at multispecialty government zonal hospital. Total 137 IHCP patients were managed during the study period from 01 Jan 2017 to 30 Jun 2019. Incidence and pregnancy outcome in form of several maternal and fetal factors were analysed by appropriate statistical test using spps software version 20.0.
Results: During the study period total 4872 patients were undergoing delivery and 137 patients were diagnosed with IHCP. The incidence of IHCP was 2.81%. Majority of cases 75 out 137 (54.74%) were nulligravida. Total 29.92% (41/137) cases were underwent LSCS delivery and of this 21.17% (29/137) were primary caesarean delivery. There were three still birth noted in IHCP study population. Total 28 cases (20.44%) of IHCP were presented with preterm labour. And NICU admissions of the study population were 32 new born babies (23.36%). 2.18% case of still birth was noted among study population.
Conclusions: IHCP causes significant maternal and neonatal morbidity and is major contributor of preterm delivery, caesarean delivery, meconium stained liquor and NICU admission.
Geenes V, Williamson C, Chappell LC. Intrahepatic cholestasis of pregnancy. The Obstet Gynaecol. 2016;18(4):273-81.
Glantz A, Marschall HU, Mattsson LA. Intrahepatic cholestasis of pregnancy: relationships between bile acid levels and fetal complication rates. Hepatol (Baltimore, Md). 2004;40(2):467-74.
Mays JK. The active management of intrahepatic cholestasis of pregnancy. Current Opinion Obstet Gynecol. 2010;22(2):100-3.
Geenes V, Chappell LC, Seed PT, Steer PJ, Knight M, Williamson C. Association of severe intrahepatic cholestasis of pregnancy with adverse pregnancy outcomes: a prospective population-based case-control study. Hepatol (Baltimore, Md). 2014;59(4):1482-91.
Ray ATR, Balsara R, Singhal S. Cholestasis of pregnancy. J Obstet Gynecol India. 2005;55:247-50.
Padmaja M, Bhaskar P, Kumar GJ, Seetha R, Mahasweta C. A study of obstetric cholestasis. J Obstet Gynaecol India. 2010;60(3):225-31.
Gupta AKT, Gupta Y, Hak J. Cholestasis of pregnancy. J Obstet Gynecol India. 2009;59(4):320-3.
Medda SSS, Palo U. A study of the outcome of pregnancy complicated by obstetric cholestasis. Int J Reprod Contracept Obstet Gynecol. 2018;7:996-1001.
Kant AGS, Gupta U, Razdan A, Amle D. Maternal and perinatal outcome in cholestasis of pregnancy: a study in tertiary care hospital in North India. Int J Reprod Contracept Obstet Gynecol. 2018;7:5066-70.
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 Gynaecol India. 2010;60(5):413-8.
Al Shobaili HA, Hamed HO, Al Robaee A, Alzolibani AA, Amin AF, Ahmad SR. Obstetrical and fetal outcomes of a new management strategy in patients with intra-hepatic cholestasis of pregnancy. Arch Gynecol Obstet. 2011;283(6):1219-25.
Wikstrom Shemer EA, Thorsell M, Marschall HU, Kaijser M. Risks of emergency cesarean section and fetal asphyxia after induction of labor in intrahepatic cholestasis of pregnancy: a hospital-based retrospective cohort study. Sexual and reproductive healthcare: Official J Swedish Asso Midwives. 2013;4(1):17-22.
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(4 Pt 1):957-60.
Mahajan NAA, Lone MI. Outcome of pregnancy complicated by obstetric cholestasis: a prospective study. IJSS. 2017;5(3):271-4.