European Journal of Biomedical and Pharmaceutical Sciences

GESTATIONAL AGE AT DELIVERY AND MATERNAL AND PERINATAL OUTCOMES IN WOMEN WITH INTRAHEPATIC CHOLESTASIS OF PREGNANCY (IHCP)

Kalyani Nair*, Latika Sahu and Preeti Singh

ABSTRACT

IHCP is a disease of exclusion with pruritis along with unexplained elevated levels of liver enzymes and/ or elevated serum bile acids which resolve after delivery. It is associated with increased rates of caesarean delivery, postpartum hemorrhage, spontaneous preterm labour, antepartum passage of meconium, fetal distress, fetal sphyxial events, fetal mortality and NICU admission. The objective was to study the gestational age at delivery and its association with maternal and perinatal outcomes in women with IHCP. Patients with IHCP beyond 28 weeks of gestation were evaluated clinically. Liver function tests (LFT) along with serum Bile acids were done every 2 weekly. They were managed according to hospital protocol. Decision for induction of labor or spontaneous delivery was taken according to department/unit protocol and trend of biochemical tests such as AST, ALT and serum bile acid. Patients were followed up till delivery and 2 weeks postpartum. Adverse maternal and perinatal outcomes were noted. LFT was done 2 weeks postpartum. A total of 150 cases of IHCP were recruited of which 77.3% were cases of mild IHCP and 22.7% were severe IHCP. Induction of labour was done in 87.3% of patients and 10% delivered spontaneously. Elective cesarean section was done in 2.7%. Maximum number of patients 74.7% (N=112) were induced between 37-38+6 weeks gestation. Preterm delivery occurred in 5.9% of patients. Cesarean rate observed was 34% and did not alter significantly with different gestational age at delivery. Major PPH was observed in 1.3% (2) of patients. There was one case of stillbirth. Low birth weight babies were 26% (39). There was one case of stillbirth and one case of asphyxia. Meconium stained liquor was seen in 9.3% (14) of patients. NICU admission and neonatal jaundice was seen in 9%(6) and 8.7% (13) patients respectively and was significantly higher in babies delivered at earlier gestational age. In conclusion, in patients with IHCP, termination of pregnancy can be considered after 37 completed weeks. In those patients who show a rising trend of serum bile acid >40 μmol/L or those who have values above 100 μmol/L, termination should be considered after 34 completed weeks due to risk of stillbirth keeping in mind the risks of prematurity. Therefore the decision for termination of pregnancy should be individualized taking into account the serum bile acid level of the patient.

Keywords: IHCP, Obstetric cholestasis, Cholestasis in pregnancy.