OBSTETRIC CHOLESTASIS

*Dr. Seema Dande

ABSTRACT

Intrahepatic cholestasis of pregnancy {ICP} is a disorder characterised by pruritus with the onset in the second and third trimester of pregnancy. The serum bile acids and aminotransferases are raised. The incidence is higher in Chile and Bolivia. Around 5 to 15% genetic, environmental and hormonal factors contribute to the pathogenesis of ICP. Mother suffers from pruritus which is more in palms and soles. It causes difficulty in getting good sleep as this happens more at night. However the effect can be dangerous to the fetus. The risk of preterm delivery is 19 to 60%, meconium staining of amniotic fluid is 27%, fetal bradycardia is 14%, fetal distress 22 to 41% and unexplained fetal death 0.4 to 4.1%. If the bile acids are more than 40 micromol/litre the risk of fetal death is high. Hence it is recommended to deliver the fetus by 37 weeks of gestation.

Keywords: Primary biliary cirrhosis, Intrahepatic cholestasis, Primary sclerosing cholangitis.