Perinatal Outcomes among Women with Cholestasis of Pregnancy

Abstract

Introduction: 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. Materials and methods: The data were collected by retrospective record review for the past 2 years and the information collected included obstetrical outcomes and complications in mothers with ICP admitted in a tertiary care hospital. Results: Among the 64 pregnant women admitted with ICP, 56.2% of women were booked pregnancies and 47 (73.4%) were in the age groups of 21-30 years. Most women presented with ICP at gestational ages of >37 weeks 51 (79.9%), with the onset of symptom around 33-36 weeks of gestation 21 (32.8%). Common complications encountered were severe preeclampsia and gestational diabetes mellitus 6 (9.3%). Among neonates, meconium-stained liquor (MSL) and low appearance pulse rate grimace activity respiration (APGAR) at 1 minute were common complications. Mothers with ICP were induced with PGE2 (dinoprostone) and 54.7% delivered vaginally. Pregnancies induced with PGE2 and PGE1 (misoprostol) had a higher chance of undergoing lower segment cesarean section (LSCS) 19 (29.6%). Conclusion:Mothers with ICP should be screened antenatally for preeclampsia. The delivery team should be prepared to manage meconium aspiration in the newborn, although most patients deliver vaginally. Key message: Newer modalities of treatment with better pregnancy outcomes in mothers with ICP.

Comparative Study of Mifepristone with Dinoprostone Gel in Induction of Labor in Full-term Pregnancy: An Open-label Randomized Controlled Trial

“…Hapangama and Neilson 3 did a Cochrane review including 1,108 women of 10 trials and found that mifepristone-treated women were more likely to be in labor or to have favorable cervix at 48 hours (RR 2.41, 95% confidence interval 1.7-3.42); these women had less chances to have LSCS (RR 0.74, 95% confidence interval 0.6-0.92). Minimum effective dose of mifepristone was 200 mg. Vijay et al 13 studied perinatal outcome in patients with cholestasis and found that pregnancies induced with PGE2 (dinoprostone) and PGE1 (misoprostol) had 54.7% chance of undergoing lower segment cesarean section.…”

Adverse Fetal Outcomes in Patients with Low Amniotic Fluid Index: Presenting Care Hospital Setting

“…The ultimate goal is to refine prenatal care protocols, thereby contributing to the improved health and well-being of both the mother and the developing fetus. This research not only underscores the importance of maintaining optimal AFI levels but also provides invaluable insights into clinical practice, paving the way for advancements in antenatal care techniques and pregnancy outcomes (5). Through this comprehensive approach, the study bridges existing knowledge gaps and furthers our understanding of the critical role played by AFI in fetal development.…”

Evaluation of bile acid and deranged liver function test in obstetrics cholestasis in pregnancy in fetal and perinatal outcome

“…2 Although maternal invariably increased fetal risk , namely preterm delivery, low birth weight babies, bradycardia, meconium staining of amniotic fluid, fetal distress, intrauterine death of fetus. 3 Both spontaneous and iatrogenic MSL, RDS, increased neonatal ICU admission. 4…”