Maternal and Perinatal Outcome in Patients with Cholestasis of Pregnancy

Cholestasis is defined as decrease in bile flow due to impaired secretion by hepatocytes or obstruction of bile flow through intrahepatic or extrahepatic bile ducts. Intrahepatic cholestasis of pregnancy is a condition characterized by pruritis in the second half of pregnancy. It persists until delivery after which it caeses promptly. A genetic background is suggested by family clustering and demographic variation, with highest incidence reported from Chile Bolivia (6%-27%) and Sweden (11.5%) (1). Cholestasis is a rare disease and rates vary dramatically with overall prevalence estimated as 1 in 1000 to 1 in 10,000 pregnancies in North America, Asia and Australia (2). The incidence of obstetric cholestasis varies from 1% to1.5% of pregnancies in Europe (3). The etiology of obstetric Cholestasis is multifactorial and genetic. Environment and hormonal factors have important roles (4). Prevalence in w4w1omen of Indian Origin is 5% (5). The prevalence may have seasonal cycles and may be more prevalent in winters (6) . Intrahepatic cholestasis of pregnancy can have devastating consequences for the fetus with perinatal mortality reaching upto 11% 20% in untreated cases. (7). Obstetrics cholestasis classically manifests itself in 2nd or 3rd trimester of pregnancy with generalized pruritis but without any skin rash being the main complaint. Pruritis begins in the palms and soles with progression to arms and legs eventually reaching trunk and face. Jaundice is relatively uncommon complication, except in most severe and prolonged cases (8). Although the maternal outcome is invariably good, but an increased fetal risk has been reported namely preterm delivery, low birth weight babies, bradycardia, meconium staining of liquor, fetal distress, Intrauterine death of fetus and increased perinatal mortality (9) . The mechanism of premature labour and meconium staining of liquor has been attributed to elevated bile acids in circulation. (10). Bile acids especially cholic acid, cause a dose dependant vasoconstrictive effect on isolated human placental chorionic veins, an abrupt decrease in oxygenated blood flow to fetus, leading to fetal distress and IUD (11). The hallmark of cholestasis is evaluated by measuring aminotrans ferases , alkaline phosphatase and bilirubin. Introduction Abstract The current study was undertaken to determine the effects of obstetrical cholestasis on the mother and fetus. 150 pregnant patients presenting with pruritis and having deranged liver function tests were taken for this study. 150 patients diagnosed with ICP were studied. The prevalence of the disease was 1.006%. Maximum number of patients were primigravida and in age group of 21-25 years. Pruritis was present in 58.67% of patients and was noted more in winter. Jaundice was seen in 28.67% of patients. Onsent of labour was spontaneous in 50.67% of patients and preterm delivery in 10% of patients. Induction of Labour was done in 39.33% of patients. Vaginal delivery occured in 57.33% of patients. 10% patients had elective LSCS due to obstetrical indication while as 28.82% had LSCS due to fetal distress i.e. meconium and fetal bradycardia. 11patients had PPH. IUD was seen in 2.67% of patients and 16% of neonates required NICU admission and out of 24 NICU admissions, 62.5% were due to meconium aspiration syndrome. Obstetric cholestasis is associated with increased perinatal mortality and morbidity if delivered after 38 weeks. An attempt to deliver prior to 38 weeks may improve perinatal outcome.