DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20203296

Cholestasis of pregnancy: effects on maternal and fetal outcome

Nazia Hassan, Rabia Khurshid, Mudasir Muzamil, Shameema Parveen

Abstract


Background: Intrahepatic cholestasis of pregnancy (ICP) typically occurs in late pregnancy affecting 1.5-2% pregnancies. Limited data is available regarding its fetal and maternal implications. This study aims to assess the impact of ICP on maternal and fetal outcome.

Methods: A total 200 patients with pruritus in later half of pregnancy were studied over a period of 18 months out of which 135 were diagnosed as ICP. Clinical and biochemical parameters like serum aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total protein, and gamma glutamyl transferase was recorded. Maternal and fetal outcome was noted in the form of LSCS rate, preterm births, fetal distress and neonatal ICU admissions.

Results: In this study, most common symptom was pruritus. Most of cases had onset of symptoms between 32-36 weeks. High LSCS rates were seen among cases. Intrapartum complications viz. meconium staining of amniotic fluid (57.8%), preterm delivery (11.9%), fetal distress (42.2%) were significantly higher in study population and there was high incidence of NICU admissions (49. 6% neonates) among cases mostly due to meconium aspiration and prematurity.

Conclusions: ICP increases maternal morbidity and is associated with adverse perinatal outcome viz. increased risk of fetal distress, preterm births and sudden IUD at term as evidenced in this study. A timely intervention at 37-38 weeks will reduce the adverse outcomes.


Keywords


Fetal distress, Intrahepatic cholestasis of pregnancy, Labour, Preterm, Pregnancy

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References


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. 2014;59:1482-91.

Misra R. Ian Donalds Practical Obstetric Problem, 7th Ed. BI Publications Pvt Ltd: New Delhi; 2014:142-147.

Benjaminov FS, Healthcote J. Liver disease in pregnancy. Am J Gastroenterol. 2004;99:2479-88.

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

Rook M, Vargas J, Caughey A, Bacchetti P, Rosenthal P, Bull L. Fetal outcomes in pregnancies complicated by intrahepatic cholestasis of pregnancy in a Northern California cohort. PLoS One. 2012;7(3):e28343.

Royal college of obstetrics and gynecologists green top 43 (19.5.11). Available at: https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_43.pdf. Accessed on January 2014.

Hay JE. Liver disease in pregnancy. Hepatol. 2008;47(3):1067-76.

Catherine Nelson Piercy. Handbook of Obstetric Medicine 3rd Edition, CRC Press; 2006:6:1816.

Milkiewiez P, Elias E, Williamson C, Weaver J. Obstetric cholestasis: may have serious consequences for the fetus, and needs to be taken seriously. BMJ. 2002;324:123-4.

Lammert F, Marschall HU, Glantz A, Matern S. Intrahepatic cholestasis of pregnancy: molecular pathogenesis, diagnosis and management. J Hepatol. 2000;33(6):1012-21.

Oude Elferink RP, Paulusma CC. Function and pathophysiological importance of ABCB4 (MDR3 P-glycoprotein). Pflugers Arch. 2007;453(5):601-10.

Kreek MJ. Female sex steroids and cholestasis. Semin Liver Dis. 1987;7(1):8-23.

Gonzalez MC, Reyes H, Arrese M, et al. Intrahepatic cholestasis of pregnancy in twin pregnancies. J Hepatol. 1989 Jul;9(1):84-90.

Reyes H, Baez M, Gonzalez MC. Selenium, zinc and copper plasma levels in IHCP, in normal pregnancies and in healthy individuals in Chile. J Hepatol. 2000;32(4):542-9.

Alsulyman OM, Ouzounian JG, Ames-castro M. IHCP; perinatal outcome associated with expectant management, Am J Obstet Gynecol. 1996;175(4 Pt 1):957-60.

Rizvi SM, Raina R. Fetomaternal outcome in jaundice complicating pregnancy. J Soc Obstet Gynaecol Pak. 2018;8(3):176-9.

Brouwers L, Koster MP, Page-Christiaens GC, Kemperman H, Boon J, Evers IM, et al. Intrahepatic cholestasis of pregnancy: maternal and fetal outcomes associated with elevated bile acid levels. Am J Obstet Gynecol. 2015;212(1):100.e1-7.

Ehsan A, Ehsan-ul-Haq M. Maternal and fetal outcome in patients with obstetrics cholestasis. J Soc Obstet Gynaecol Pak. 2018;8(4):227-31.