PERINATAL OUTCOMES AMONG WOMEN WITH INTRAHEPATIC CHOLESTASIS OF PREGNANCY IN A SECONDARY CARE CENTRE: A PROSPECTIVE STUDY

Dr. Twinkle Sood and *Dr. Divya Dhiman

ABSTRACT

Background: Intrahepatic cholestasis of pregnancy (ICP), also described as obstetric cholestasis is the second most common cause of icterus in pregnancy. Although not fully understood, proposed theories indicate it could be due to decreased bile flow through the liver and its poor excretion, leading to increased levels of colic and chenodeoxycholic acid. It is known to be associated with adverse maternal and fetal outcomes. Methods: This was a prospective observational study carried out in a secondary care hospital. Total 800 pregnant women were screened during the study period. Patients with ICP were identified in out-patient department (OPD) of obstetrics and gynaecology after eliciting history about itching. Pregnancies with pregnancy induced hypertension and other liver diseases in pregnancy were excluded. Results: 64 pregnant women with prevalence rate of 8% were found to be suffering from ICP. Majority of the population suffering from ICP were multiparous women (65.6%) in the age group of 26-30 years (54.7%). Most common foetal complications encountered were meconium staining of liquor (46.9%) and low birth weight (45.3%). Other adverse foetal outcomes were preterm delivery, abnormal CTG and increased risk of NICU admissions. Maternal complications included increased chances of lower segment caesarean section (LSCS) (57.8%), insomnia (59.4%), PPROM (17.2%) and PPH (18.8%). Conclusions: Proper history taking should be undertaken to screen women with ICP in the antenatal period. The delivery team should be prepared to manage meconium aspiration in the newborn.

Keywords: Intrahepatic cholestasis of pregnancy, perinatal complications, secondary care.