Obstetric outcome in women with intrahepatic cholestasis: A 3-year study in a tertiary care hospital in Bengaluru

Abstract

Objective: To study the incidence and obstetric outcome of pregnancies complicated by intrahepatic cholestasis. Materials and methods: A retrospective case control study of 60 women with obstetric cholestasis was carried out in the Department of Obstetrics and Gynecology, St. John’s Medical College Hospital, Bengaluru from January 2015 to March 2018. Statistical analysis was performed using the Z/T test when appropriate. A pvalue less than or equal to 0.05 was considered statistically significant. Results: The frequency of intrahepatic cholestasis of pregnancy (ICP) was 60 among 8319 deliveries (7.21%). The most common symptom was generalized pruritus, which appeared in 36.6% during the 2nd trimester and 83.3% in the 3rd trimester of cases. Preeclampsia was seen in 31.6% (3.3% in controls); preterm deliveries were seen in (23% vs 5%). A higher incidence of meconium-stained amniotic fluid (25% vs 6.7%) was noted at delivery. The cesarean section rate was 41.7% vs 23.3%. There was no significant difference in the CTG changes, APGAR score less than 7, intrauterine growth restriction, NICU admission or perinatal mortality between cases and controls. Conclusion: Multidisciplinary approach involving obstetricians, gastroenterologists and neonatologists improved the obstetric outcome. Early diagnosis was done with liver function tests (aminotransferases) and urinary bile salts and bile pigments. In most of the cases, antihistaminics and emollients relieved the symptoms. Ursodeoxycholic acid (UDCA) treatment is found to be effective in reducing the persistent pruritus.