Maternal and fetal outcome in intrahepatic cholestasis of pregnancy at tertiary care institute of North India
Open Access
- 1 July 2021
- journal article
- Published by Scientific Scholar in Indian Journal of Medical Sciences
- Vol. 73, 335-339
- https://doi.org/10.25259/ijms_446_2020
Abstract
Objectives: Intrahepatic cholestasis of pregnancy (IHCP) is the most common reversible form of hepatic disease in pregnancy. The risk of sudden intrauterine infant death is major threat as none of the fetal monitoring proved effective for its prevention. This study was conducted to know the prevalence of IHCP along with fetal and maternal outcome in North Indian population. Material and Methods: This case–control study was conducted over a period of 6 months. One hundred pregnant patients were recruited in each group. Patients with IHCP were included in case group whereas apparently healthy pregnant women with singleton pregnancy were included in control group. Bile acids were done only once at the time of initial visit whereas liver enzymes were done at initial visit and subsequently weekly for total 3 times. All cases of IHCP were started on ursodeoxycholic acid (UDCA) with a dose of 10–15 mg/kg/day throughout pregnancy and three doses of 10 mg Vitamin K by intramuscular route were also given. Fetal and maternal outcomes were compared between both the groups. Total numbers of deliveries in that time period were also noted to find out the prevalence of disease. The tests of two or more proportions were done using Fisher’s exact test and Chi-square test. P < 0.05 was considered statistically significant. Results: The prevalence of IHCP was 4.08% in our population, however, women from urban area had higher incidence of cholestasis than rural population. History of recurrent disease was found in 30% of women. Out of 100, 96% presented with itching and only 57–58% had raised liver enzymes levels. In 89% of patients (89/100), bile acids levels were >14 μmol/l. During follow-up, SGOT and SGPT levels were significantly improved over 2-week interval while on treatment with UDCA; however, levels were still on higher side. There was no correlation found between cholestasis of pregnancy with preterm labor and meconium-stained liquor in the present study. Comparable results were found in terms of respiratory distress syndrome and NICU admission, whereas significant high incidence of neonatal jaundice found in the control group. Conclusion: Itching over whole body was the predominant presenting complaints of cholestasis of pregnancy. Diagnosis should be supported by bile acids in women with normal liver enzymes to decrease the cost of investigations. Early termination of pregnancy between 36 and 37 weeks can be considered in women with bile acids >40 μmol/L and in non-compliant patients on UDCA treatment.Keywords
This publication has 19 references indexed in Scilit:
- ACOG Committee Opinion No. 764: Medically Indicated Late-Preterm and Early-Term DeliveriesObstetrics & Gynecology, 2019
- Pregnancy and bile acid disordersAmerican Journal of Physiology-Gastrointestinal and Liver Physiology, 2017
- Two cases of first onset intrahepatic cholestasis of pregnancy associated with moderate ovarian hyperstimulation syndrome after IVF treatment and review of the literatureJournal of Obstetrics and Gynaecology, 2017
- Postpartum Blood Loss in Women Treated for Intrahepatic Cholestasis of PregnancyObstetrics & Gynecology, 2016
- New Insights on Intrahepatic Cholestasis of PregnancyClinics in Liver Disease, 2015
- Severe intrahepatic cholestasis of pregnancy is a risk factor for preeclampsia in singleton and twin pregnanciesAmerican Journal of Obstetrics and Gynecology, 2015
- The risk of infant and fetal death by each additional week of expectant management in intrahepatic cholestasis of pregnancy by gestational ageAmerican Journal of Obstetrics and Gynecology, 2015
- Liver disease in pregnancyWorld Journal of Gastroenterology, 2009
- Bile acids increase response and expression of human myometrial oxytocin receptorAmerican Journal of Obstetrics and Gynecology, 2003
- The wide spectrum of multidrug resistance 3 deficiency: From neonatal cholestasis to cirrhosis of adulthoodGastroenterology, 2001