Feto-Maternal outcomes in Intrahepatic Cholestasis in Pregnancy in a Tertiary Care Centre in Eastern Nepal

Abstract

Background Intrahepatic cholestasis of pregnancy has poor feto-maternal outcomes. To date there has been sparse publications regarding impact of intrahepatic cholestasis in feto-maternal outcomes in our setting. Therefore, we aimed to study the feto-maternal outcome in patients with intrahepatic cholestasis of pregnancy.Material and Methods A hospital based prospective cross-sectional study carried out in department of Obstetrics and Gynecology of Nobel Medical College, Biratnagar, Nepal from 1st January 2014 to 30th December 2015 in women who presented with pruritus in third trimester of pregnancy and having deranged liver function tests. All the cases were followed from admission to discharge. Socio-demographic, clinico-laboratory profile and feto-maternal outcomes were recorded in a preformed structured proforma. Descriptive statistics was used to present the data.Results Among 6,780 women admitted for delivery, 80 had cholestasis of pregnancy with incidence of 1.15%. 83% were of 18-35 years and 65% were primigravida. Most distressing symptom was generalized pruritus (75.0 %). The cesarean delivery rate was 46.25% and labor induction rate was (47.5%). Fetal complications were seen in majority of cases that included meconium aspiration syndrome 26 (32.5%), intrapartum fetal distress 21 (26.25%) and requirement of: intensive care 38 (48.75%). There were 7 perinatal and 3 neonatal deaths.Conclusion Intrahepatic cholestasis of pregnancy seems fairly common among pregnant women. It may be responsible for a large number of perinatal and neonatal deaths especially after 36 weeks of gestation. A large prospective study is needed to address the problems in time.Journal of Nobel Medical College Volume 5, Number 1, Issue 8, January-July 2016, 20-25

Obstetric Cholestasis among Pregnant Women Visiting a Tertiary Care Centre

“…8 The most frequent chief complaint by women was pruritus of the whole body in 70%, the finding is similar to one of the study. 2 The weeks of gestation at diagnosis majority (90%) at 27-40 weeks with a mean of 31.38±4.56 weeks, Study reports the mean gestational age at diagnosis was 36.11±2.75 weeks, 9 32.53±4.68, 10 38 weeks 4 days 11 respectively slightly different from our finding. 9 - 11 More than 97% of case were diagnosed in third trimester which is consistent with this study.…”

“…Likewise, 56.25% of patients were taking tablet UDCA 150 mg twice a day followed by 32.5% were given UDCA 300 mg twice a day while 9 (11.8%) were taking UDCA 300 milligrams (mg) thrice a day. 2 , 10 Similarly, 82.5% of women delivered at term 37-42 weeks of gestation with a mean of 35.51 ±3.27 weeks and the median gestational weeks was 37 similar to the finding done in another teaching hospital in Nepal. 12 …”

“…The majority of women 85% had LSCS that includes (40% emergency and 45% elective),the finding are not consistent with finding by another authors as their studies reports (46.25%), 2 (43.4% ), 8 (60.69%) 10 LSCS respectively. The variation in finding could be due to different time of antenatal visit and delivery because of patient profile.…”

“…However, higher than the study in eastern part of the Nepal (1.15%), the difference in prevalence could be because of the variance in sample size as well as settings. 2 …”

“…The incidence of ICP among Indian women reported is around 1% and in Eastern Nepal 1.15%. 2 The prevalence of overall ICP is around 0.1-2%, whereas in the Asian Indian population, it is around 1.2-1.5%. 3 - 5 …”