European Journal of Molecular & Clinical Medicine

Abstract

Background : Intrahepatic cholestasis of pregnancy (ICP) is a multifactorial condition of pregnancy characterised by pruritis in the absence of a skin rash ,with , raised bile acids, and/or abnormal liver function tests neither of which has an alternative cause and both of which resolve after delivery. We in the current study tried to evaluate maternal and perinatal outcomes in cases and controls in obstetrics department presenting at our hospital .
Methods: Antenatal patients complaining of unexplained pruritis without rash, with  raised bile acids and/or abnormal LFTs   were included in our prospective one year case-control study. There were 60 cases of ICP  in our study and 60 controls .  Maternal and perinatal outcomes were compared in both groups and statistical analysis was performed using chi-square test and fisher exact test . ‘p’ value < 0.05 was considered as statistically significant in this observational study .
Results : Sleep disturbance due to pruritis was present in 93.3% of the cases. Abnormalities in ALT and AST levels were seen in 98.3% and 100% cases respectively. Total bile acid levels were assessed for all the cases. 88.4 % of  cases with ICP had mildly elevated bile acids ( 10-40 micromol/L) whereas severe derangement (>40 micromol/L) was seen in 11.7% of the cases. Mean POG at delivery was lower in cases (36.78 weeks with SD 1.76)  than controls (38.09 weeks with SD 0.83 weeks).Significantly high Cesarean rates were seen among cases (65%) compared to the control group (40%). Meconium stained liquor was present in 47.3% of the total live births in cases compared to 5% in the control group.. Out of 60 cases diagnosed with ICP, 57 (95%) were live births whereas 3 (5%) were IUFDs . LFTs were in the normal range in 100%  of cases 6 weeks postpartum . . 98.2% of total live born neonates were alive and healthy.
Conclusion : Our study was a prospective case control study with 60 cases diagnosed as ICP and same number of age and parity matched controls with  Raised bile acids were found to be associated with fetal and  neonatal outcomes like IUD, neonatal death, prematurity, need for assisted ventilation and NICU care, small for gestational age babies.
Maternal outcomes like higher LSCS deliveries, troublesome symptoms as pruritis and sleep disturbance have been studied.