DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20191939

Cholestasis of pregnancy: a prospective analysis from a South Andaman teaching hospital

Bhabani Pegu, Manju Mehrotra, Anita Yadav, Pinky S. K. Sahoo

Abstract


Background: Intrahepatic cholestasis of pregnancy (IHCP) is one of the commonest pregnancy related liver disorder. Although the maternal course is usually benign, there is an increased risk of spontaneous preterm delivery, fetal compromise, meconium stained amniotic fluid and even intrauterine fetal demise. The objective of this study was to study the incidence of IHCP and its impact on maternal and perinatal outcome.

Methods: A prospective study carried out in 68 number of IHCP cases. Diagnosis was done on the basis of clinical and laboratory parameters. All the cases were followed up to the puerperium to find out maternal and perinatal outcome.

Results: The incidence of cholestasis of pregnancy was 2.73%. Most (88%) of the cases were presented with generalized pruritus, relived with ursodeoxycholic acid and complete recovery was observed after delivery. The rate of instrumental delivery was 8.82% and caesarean section rate was 30.88%. Most common indication of caesarean section was fetal distress and non-progress of labour. There was one stillbirth at 35 weeks however none of the mother had complication during labour or puerperal period.

Conclusions: Increased level of liver enzymes in patients of IHCP associated with poor perinatal outcome. Therefore, careful monitoring during antenatal period and termination of pregnancy at term will result in favourable outcome of both mother and baby.


Keywords


Cholestasis, Feto-maternal outcome, Pregnancy

Full Text:

PDF

References


Ambros-Rudolph CM, Glatz M, Trauner M, Kerl H, Müllegger RR. The importance of serum bile acid level analysis and treatment with ursodeoxycholic acid in intrahepatic cholestasis of pregnancy: a case series from central Europe Archives of dermatology. 2007;143(6):757-62.

Ambros-Rudolph CM, Müllegger RR, Vaughan- Jones SA, Kerl H, Black MM. The specific dermatoses of pregnancy revisited and reclassified: results of a retrospective two-center study on 505 pregnant patients. J Am Acad Dermatol. 2006;54(3):395-404.

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

Lee RH, Goodwin TM, Greenspoon J, Incerpi M. The prevalence of intrahepatic cholestasis of pregnancy in a primarily Latina Los Angeles population. J Perinatol. 2006;26(9):527-32.

UK: Royal College of Obstetricians and Gynaecologists Obstetric cholestasis Green-Top Guideline No 43. rcog.org. Available at: http://www.rcog.org.uk. Accessed June 2017.

Lammert F, Marschall HU, Glantz A. Intrahepatic cholestasis of pregnancy: molecular pathogenesis, diagnosis and management. J Hepatol. 2003;33:1012-21.

Heinonen S, Kirkinen P. Pregnancy outcome with intrahepatic cholestasis. Obstet Gynaecol. 1999;94:189-93.

Catherine W, Laura H, Dimtrios G. Clinical outcome in a series of cases of obstetrics cholestasis identified via a patient support group. BJOG. 2004;111:676-81.

Kondrackiene J, Kupcinskas L. Intrahepatic cholestasis of pregnancy- current achievements and unsolved problems. World J Gastroenterol. 2008;14(38):5781-8.

Sharma N, Panda S, Santa Singh A. Obstetric outcome during an era of active management for obstetrics cholestasis. J Obstet Gynecol India. 2015:1-4.

Pata O, Vardareli E, Ozcan A. Intrahepatic cholestasis of pregnancy: correlation of preterm delivery with bile acids. Turk J Gastroenterol. 2011;22(6):602-5.

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

Alakananda, Bhattacharrya A, Kavita. Feto-maternal Outcome in intrahepatic cholestasis of pregnancy. Sch J App Med Sci. 2016;4(10D):3837-41.

Kenon AP, Piercy CN, Gorling J. Obstetric cholestasis, outcome with active management: a series of 70 cases. BJOG. 2002;109:282-8.

Glantz A, Marschall HU, Mattsson LA. Intrahepatic cholestasis of pregnancy: relationship between bile acid levels and fetal complication rates. Hepatol. 2004;40:467-74.

Singh G, Sidhu MK. Cholestasis of pregnancy: A prospective study 2007. MJAFI. 2008;64:343-5.

Padmaja M, Bhaskar P, Kumar GJ, Seetha R, Mahasweta C. A study of obstetric cholestasis. J Obstet Gynecol India. 2010;60(3):225-31.

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 of Obstet Gynecol India. 2010;60(5):413-8.

Amita G, Tania K, Yudhishtervir G, Jyoti H. Cholestasis of pregnancy. J Obstet Gynecol India. 2009;59(4):320-3.

UK: Royal College of Obstetricians and Gynaecologists Obstetric cholestasis Green-Top Guideline No 43. rcog.org. Available at: http://www.rcog.org.uk. Accessed June 2017.

Germain AM, Kato S, Carvajal JA, Valenzuela GJ, Valdes GL, Glasinovic JC. Bile acids increase response and expression of human myometrial oxytocin receptor. Am J Obstet Gynecol. 2003;189(2):577-82.