A Study of Obstetric Intrahepatic Cholestasis and Its Maternal and Perinatal Outcome at a Tertiary Care Hospital in Nagpur

Abstract

BACKGROUND Intrahepatic cholestasis of pregnancy (ICP) is a multifactorial pregnancy specific liver disorder which is also known as obstetric cholestasis. The purpose of this study was to establish the value of maternal serum bile acid in diagnosis of ICP, evaluate the treatment of ICP with UDCA (ursodeoxycholic acid) and its influence on maternal and neonatal outcome. METHODS It was a cross-sectional study. 90 women diagnosed with ICP were studied for a period of 2 years and 3 months at tertiary care government hospital. Statistical analysis was performed using chi square test. ‘P’ value of < 0.05 was considered as statistically significant in this observational study. RESULTS The present study evaluates that ICP is more common in multigravida and in age group of 26 years – 30 years. It recurs in subsequent pregnancies significantly. Itching, most common symptom is commenced at 34 weeks ± 2.85 weeks. Transaminases were normal with elevated serum bile acid levels in 32.33 % cases. The mean gestational age at delivery ranged between 35 to 39 weeks. Most common mode of delivery is lower segment caesarean section (LSCS) with commonest indication as meconium-stained amniotic fluid (MSAF) and 31 babies required neonatal intensive care unit (NICU). CONCLUSIONS Precise diagnosis, follow up, target medication and active management is required. Although maternal outcome for patients is good and without any long-term sequelae, fetal outcome can be devastating. Active management with close antenatal surveillance of the fetus is usually recommended for better perinatal outcome. KEYWORDS Intrahepatic Cholestasis of Pregnancy (ICP), Ursodeoxycholic Acid (UDCA), Neonatal Intensive Care Unit (NICU), Lower Segment Caesarean Section (LSCS)