COMPARISON OF MEDICAL AND SURGICAL CHOLESTASIS IN PREGNANCY: A PROSPECTIVE OBSERVATIONAL STUDY
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Keywords
Cholestasis of pregnancy, Medical cholestasis, Surgical cholestasis, Pregnancy, Fetal outcome
Abstract
Cholestasis during pregnancy is a significant hepatobiliary disorder associated with maternal discomfort and adverse fetal outcomes. It may be classified into medical cholestasis, primarily due to functional hepatic dysfunction, and surgical cholestasis, resulting from mechanical biliary obstruction. Differentiation between the two is essential for appropriate management.
Objectives: To compare the clinical profile, laboratory parameters, imaging findings, management strategies, and maternal–fetal outcomes between medical and surgical cholestasis in pregnancy.
Materials and Methods: This prospective observational study included 50 pregnant women diagnosed with cholestasis at a tertiary care hospital. Patients were categorized into medical cholestasis (n=35) and surgical cholestasis (n=15). Clinical features, biochemical parameters, ultrasonography findings, treatment modalities, and maternal and fetal outcomes were analyzed.
Results: Medical cholestasis was more common (70%) than surgical cholestasis (30%). Pruritus was the predominant symptom in medical cholestasis, while abdominal pain and jaundice were more frequent in surgical cases. Serum bile acids and transaminases were significantly higher in medical cholestasis, whereas bilirubin and alkaline phosphatase were markedly elevated in surgical cholestasis. Adverse fetal outcomes were more frequent in medical cholestasis.
Conclusion: Medical cholestasis is more prevalent during pregnancy and is associated with higher fetal risk, while surgical cholestasis poses greater maternal morbidity. Early diagnosis and appropriate differentiation are crucial for optimizing outcomes.
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Dr. Anubha Varshney
Assistant Professor1, Department of Obstetrics and Gynaecology, Rama Medical College Hospital and Research Centre, Uttar Pradesh, India.
Dr. Shalini Raman
Assistant professor2, Department of Obstetrics and Gynecology, Era Medical College, Lucknow, Uttar Pradesh, India.
Dr. Amalanshu Raman
Assistant professor3, Department of General Surgery, Era Medical College, Lucknow, Uttar Pradesh, India.
Dr. Sanjeev Kumar Singh
Professor4, Department of General Medicine, Rama Medical College Hospital and Research Centre, Uttar Pradesh, India.
Dr. Archana
Professor5*, Department of General Medicine , Rama Medical College Hospital and Research Centre, Uttar Pradesh, India.
