Abstract

Introduction: Intrahepatic cholestasis of pregnancy (IHCP) is characterised by unexplained pruritus in pregnancy associated with abnormal liver function tests (LFTs), along with or without raised bile acids, which resolves soon after delivery. Overall prevalence of intrahepatic cholestasis is around 0.1-2%. It mainly affects patients in second and third trimester. Maternal morbidities related to obstetrics cholestasis are mainly intense pruritus, but in case of perinatal outcome, it has significant adverse effects like preterm birth, meconium stained amniotic fluid, respiratory distress syndrome, increased admission to neonatal intensive care unit (NICU) and stillbirth. Aims and objectives:The aim of this study was to evaluate different perinatal outcome in patients of intrahepatic cholestasis of pregnancy and co-relate it with the maternal bile acids levels. Material and methods:This was an observational study.All the pregnant patients with history of pruritus and abnormal liver function test, with bile acid levels > 10micromol/litre, who fits into definition of obstetric cholestasis were included in this study, as per inclusion and exclusion criteria. Results: During the study period, 54 patients were selected for the study and were divided into two groups. 33 patients in group 1 with bile acid levels <40 micromol/litre and 21 patients in group 2 with bile acid levels > 40 micromol/litre. More fetal complications were seen in group 2 when compared to group 1. There was 2 intrauterine death (IUD) and one still birth in group 2 and none in group 1. In group 2 there was 8 low birth weight babies whereas there was one baby in group 1.There were 6 babies in group 2 with respiratory distress syndrome (RDS) and required intubation whereas in group 1, 3 babies had RDS and 4 required intubation. In group 2, 10 babies required neonatal intensive care unit (NICU) admission whereas in group 1, 4 babies required NICU care. Conclusion: Increased bile acid levels are related to adverse perinatal outcome and can be used for monitoring the progress of the IHCP.However,timely decision of termination of pregnancy as opposed to inuterocontinuation of pregnancy comparing the risks over benefits plays very important role in favourable outcome of pregnancy.