INTRAHEPATIC CHOLESTASIS OF PREGNANCY: ADVERSE FETOMATERNAL OUTCOME
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Keywords
IHCP, meconium, fetal distress, bile acid, Cesarean section
Abstract
Background: Intrahepatic Cholestasis of Pregnancy (IHCP) has been observed with increased incidence of fetal distress, meconium, preterm labour, intra uterine death, postpartum hemorrhage and increased surgical interferences. So, the present study is designed with an aim to see the trends of fetomaternal outcome among cases of IHCP as well as to find the incidence of IHCP among study population.
Material and Methods: In our study out of 954 deliveries conducted, 48 patients were diagnosed with IHCP. These patients were studied to see the impact of IHCP on fetomaternal outcome.
Results: During the study period (1July 2022 -31Aug 2023), there were 954 deliveries, of which 48 (5.03%) were diagnosed with IHCP without any other co-morbidities. The mean age of these women was 27.23 ± 3.78 years in cases. Among these 43.8% were Primiparous and 56.3% were multiparous. 39 (81.3%) were in age group 20-30 years. The mean period of gestation was found to be (37.25+0.911) week and (2.9+1.98) days. the occurrence of PPH was higher among subjects with IHCP (8.3%) when compared to the subjects without IHCP (4.5%)
References
2. Labbe C, Delesalle C, Creveuil C, Dreyfus M. Early and later intrahepatic cholestasis of pregnancy (ICP): Study of adverse pregnancy outcomes. Gynecol Obstet Fertil Senol. 2018;46(4):388-94. .
3. Kenyon AP, Tribe RM, Nelson-Piercy C, Girling JC, Williamson C, Seed PT, et al. Pruritus in pregnancy: a study of anatomical distribution and prevalence in relation to the development of obstetric cholestasis. Obstet Med. 2010;3(1):25–9.
4. Abedin P, Weaver JB, Egginton E. Intrahepatic cholestasis of pregnancy: prevalence and ethnic distribution. Ethn Health. 1999;4(1–2):35–7
5. Alakananda, Bhattacharya A, Kavita. Fetomaternal outcome in intrahepatic cholestasis of pregnancy. Scholars Journal of Applied Medical Sciences. 2016;4(10D):3837-41.
6. Hepatol (Baltimore, Md). 2014;59(4):1482-91. 7. Obstetric Cholestasis (Green-top Guideline No. 43). Available from: https://www.rcog.org.uk/en/guidelinesresearch-services/ guidelines/gtg43. [Last accessed on 2021 May 19]
7. Puljic A, Kim E, Page J, Esakoff T, Shaffer B, LaCoursiere DY, et al. The risk of infant and fetal death by each additional week of expectant management in intrahepatic cholestasis of pregnancy by gestational age. Am J Obstet Gynecol 2015;212:667.e1-5.
8. ACOG committee opinion No. 764: Medically indicated latepreterm and early-term deliveries. Obstet Gynecol 2019;133:e151-5
9. Egan N , Bartels A, Khashan AS , et al: reference standard for serum bile acids in pregnancy. BJOG119:493,2012
10. Wood AM, Livingston EG, Hughes BL, et al: Intrahepatic cholestasis of pregnancy: areview of diagnosis and management. Obstet Gynecol 132(4):882,2018b
11. Arora S, Huria A, Goel P, Kaur J, Dubey S. Maternal and fetal outcome in intrahepatic cholestasis of pregnancy at tertiary care institute of North India. Indian J Med Sci 2021;73:335-9
12. Glantz A, Marschall HU, Mattsson LA. Intrahepatic cholestasis of pregnancy: relationships between bile acid levels and fetal complication rates. Hepatol (Baltimore, Md). 2004;40(2):467-74.
13. Geenes V, Chappell LC, Seed PT, Steer PJ, Knight M, Williamson C. Association of severe intrahepatic cholestasis of pregnancy with adverse pregnancy outcomes: a prospective population-based case control study. Hepatol (Baltimore, Md). 2014;59(4):1482-91
14. Morton A, Laurie J. The biochemical diagnosis of intrahepatic cholestasis of pregnancy. Obstet Med. 2019;12:76-8
15. Rafia Aziz, Farah Nabi, perinatal outcomes among pregnant women with intrahepatic cholestasis: A comparative prospective study from north india.journal of cardiovascular disease research; vol 13, issue 08,
16. Pusdekar YV, Patel AB, Kurhe KG, Bhargav SR, Thorsten V, Garces A, Goldenberg RL, Goudar SS, Saleem S, Esamai F, Chomba E, Bauserman M, Bose CL, Liechty EA, Krebs NF, Derman RJ, Carlo WA, Koso-Thomas M, Nolen TL, McClure EM, Hibberd PL. Rates and risk factors for preterm birth and low birthweight in the global network sites in six low- and low middle-income countries. Reprod Health. 2020 Dec 17;17(Suppl 3):187. doi: 10.1186/s12978-020-01029-z. PMID: 33334356; PMCID: PMC7745351.
17. Al Shobaili HA, Hamed HO, Al Robaee A, Alzolibani AA, Amin AF, Ahmad SR. Obstetrical and fetal outcomes of a new management strategy in patients with intra-hepatic cholestasis of pregnancy. Arch Gynecol Obstet. 2011;283(6):1219-25
18. Alsulyman OM, Ouzounian JG, Ames-Castro M, Goodwin TM. Intrahepatic cholestasis of pregnancy: perinatal outcome associated with expectant management. Am J Obstet Gynecol. 1996;175(4 Pt 1):957-60 Source of Support: Nil; Conflict of
19. Mahajan NAA, Lone MI. Outcome of pregnancy complicated by obstetric cholestasis: a prospective study. IJSS. 2017;5(3):271-4.
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Dr Tania Singh
Department of Obstetrics and Gynaecology- Command Hospital Air Force- Bangalore
Dr M. Rasheed
Department of Obstetrics and Gynaecology- Command Hospital Air Force- Bangalore
Dr Nagaraja N
Department of Obstetrics and Gynaecology- Command Hospital Air Force- Bangalore
Dr Charu Jain
Department of Obstetrics and Gynaecology- Command Hospital Air Force- Bangalore
Dr Shahla Yazdani
Department of Obstetrics and Gynaecology- Command Hospital Air Force- Bangalore