Pregnancy outcomes of women with pruritus, normal bile salts and liver enzymes: a case control study

Yoong, Wai; Memtsa, Maria; Pun, Stacey; West, Pamela; Loo, C Y.; Okolo, Stanley

doi:10.1080/00016340801976079

Cited by 6 publications

(10 citation statements)

References 10 publications

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“…In the present study, maximum number of babies (92.9%) had Apgar score >7 at 5 minutes. This correlates well with the studies by Wai Yoong et al (2008), Apgar score >7 at 5 minutes was found in 99% of cases and the mean Apgar score at 5 minutes was 8.9. 24 Elisabeth Wikstrom et al (2010) reported that all babies in OC groups had Apgar score >9 at 5 minutes.…”

Section: Discussionsupporting

confidence: 92%

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Foetomaternal Outcome of Obstetric Cholestasis

Mishra¹,

Panigrahy²,

Behera³

2017

jebmh

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BACKGROUND Obstetric cholestasis is a disorder of liver function commonly occurring in the third trimester of pregnancy. Clinical characters of this disorder include unexplained maternal pruritus, most common site being palms and soles, altered liver functions (elevated serum transaminases) and increased fasting serum bile acids (>10 micro mol/L) in previously healthy pregnant women. The incidence is variable geographically from 0.1% to 15.6% all over the world. The aetiology of this condition is not fully understood. Its pathogenesis is related to increased sex hormone synthesis, environmental factors and genetic predisposition. Obstetric cholestasis can lead to increased foetal morbidity and mortality with regards to preterm delivery, neonatal respiratory distress syndrome, foetal distress and sudden intrauterine foetal death. Treatment of the disease focus on relieving symptoms and signs. The aim of the study is to evaluate the pregnancy and foetal outcome of pregnant women with obstetric cholestasis. MATERIALS AND METHODS A cross-sectional study was conducted in M.K.C.G. Medical College and Hospital, Berhampur from February 2015 to May 2017. Inclusion Criteria-All patients having pruritus during course of pregnancy with biochemical evidence of raised liver function tests attending antenatal clinic or labour room. Exclusion Criteria-1) Pregnant women without pruritus; 2) Pregnant women having other liver diseases. RESULTS The incidence of obstetric cholestasis was 0.6%. Majority of cases were primigravida (72.9%). Positive family history was present in 11.4% of cases. Majority of cases (77.1%) had normal vaginal delivery. 22.9% of cases had caesarean section. Primary postpartum haemorrhage occurred in only 2.9% of cases. CONCLUSION Obstetric cholestasis can be managed by improving the circulating bile acid level, targeting the cause of pruritus and optimising the time of delivery as a result of which we can reduce adverse pregnancy outcomes.

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Section: Discussionsupporting

confidence: 92%

“…The incidence of Low Birth Weight (LBW) babies was 8.5%. Similar results were found by the Wai Yoong et al (2008); 24 Sidhu et al 2008; 23 Dang Arbinder et al 2010; 21 i.e. 3.2 kg, 2.7 kg, 2.9 kg, respectively.…”

Section: Discussionsupporting

confidence: 83%

Foetomaternal Outcome of Obstetric Cholestasis

Mishra¹,

Panigrahy²,

Behera³

2017

jebmh

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“…A total of 13 studies [[13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25]] met the inclusion criteria Fig. 1.…”

Section: Resultsmentioning

confidence: 99%

“…Five case-control [13,14,18,19,25] and eight cohort studies [[15], [16], [17],[20], [21], [22], [23], [24]]. The included studies were published between 1994 to 2016 and originated from different parts of the world including; Australia, China, Finland, India, Mexico, Saudi Arabia, Sweden, Switzerland, United Kingdom and The United States of America.…”

Section: Resultsmentioning

confidence: 99%

Stillbirth and associated perinatal outcomes in obstetric cholestasis: a systematic review and meta-analysis of observational studies

Mohan

Antoniou

Konje

et al. 2019

European Journal of Obstetrics & Gynecology and Reproductiv

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Background Obstetric cholestasis is a condition occurring in pregnancy with suspected adverse perinatal outcomes. Stillbirth is a significant adverse event associated with obstetric cholestasis and considered for intervention in pregnancy. Objectives There are multiple studies with epidemiological data with regards to the outcomes of obstetric cholestasis. Our hypothesis is to the test the association of stillbirth and related outcomes in obstetric cholestasis. Search Strategy & Selection criteria Two independent reviewers did independent searches and selection with a standardized design as outlined in the PRISMA statement. Analysis The retrieved relevant literature was subjected to a rigorous quality assessment and followed by standardized interpretable results. Results The pooled estimate in this study showed that there was no significant difference in the stillbirth rates in the obstetric (OC) population when compared to the non-obstetric cholestasis (reference) population. However, there was an increased risk of preterm birth in the OC population compared to the reference population; however, the cesarean section and induction of labor results were directly related. Discussion This study provides an epidemiological data related to the perinatal outcomes associated with obstetric cholestasis, specifically stillbirth. This result is likely to produce a benchmark for current evidence-based practice and to assist future research in understanding the implication of associated stillbirth risk and related outcomes with OC.

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“…Intrahepatic cholestasis of pregnancy (ICP) is a rare liver disorder which usually manifests in the third trimester. 1 2 3 4 5 ICP commonly presents with severe pruritus and elevated liver function tests. The pruritus may precede physical or laboratory abnormalities and is characterized by total body itching with predominance for the palms and soles of the feet.…”

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confidence: 99%

Bile Acid Determination after Standardized Glucose Load in Pregnant Women

Adams

Jacobs

Lupo

2015

AJP Rep

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Objective Intrahepatic cholestasis of pregnancy (ICP) is a rare liver disorder, usually manifesting in the third trimester and associated with increased perinatal morbidity and mortality. The hallmark laboratory abnormality in ICP is elevated fasting serum bile acids; however, there are limited data on whether a nonfasting state affects a pregnant woman's total bile acids. This study assesses fasting and nonfasting bile acid levels in 10 healthy pregnant women after a standardized glucose load to provide insight into the effects of a glucose load on bile acid profiles. Study Design Pilot prospective cohort analysis of serum bile acids in pregnant women. A total of 10 healthy pregnant women from 28 to 32 weeks' gestation were recruited for the study before undergoing a glucose tolerance test. Total serum bile acids were collected for each subject in the overnight fasting state, and 1 and 3 hours after the 100-g glucose load. Results There was a statistically significant difference between fasting versus 3-hour values. There was no statistically significant difference between fasting versus 1-hour and 1-hour versus 3-hour values. Conclusion There is a difference between fasting and nonfasting total serum bile acids after a 100-g glucose load in healthy pregnant women.

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Pregnancy outcomes of women with pruritus, normal bile salts and liver enzymes: a case control study

Abstract: This study suggests that women who have transient pruritus with normal bile salts and liver biochemistry appear to have higher intrapartum and postpartum complications and require increased vigilance. In order to evaluate this finding, further prospective studies will be required.

Cited by 6 publications

References 10 publications

Foetomaternal Outcome of Obstetric Cholestasis

Foetomaternal Outcome of Obstetric Cholestasis

Stillbirth and associated perinatal outcomes in obstetric cholestasis: a systematic review and meta-analysis of observational studies

Bile Acid Determination after Standardized Glucose Load in Pregnant Women

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