Pregnancy outcome in women with intrahepatic cholestasis of pregnancy
DOI:
https://doi.org/10.18203/2320-6012.ijrms20202273Keywords:
Intrahepatic cholestasis of pregnancy, Liver function test, Pre-term deliveryAbstract
Background: Intrahepatic cholestasis of pregnancy is a multifactorial condition of pregnancy diagnosed when otherwise unexplained pruritus with abnormal liver function test and neither of which has an alternative cause. The most appropriate gestational age for the delivery of women with ICP is yet to be determined. The present study is designed to determine whether with active intervention, pregnancy with ICP can be carried to a later gestation.
Methods: Fifty Women with diagnosed a case of ICP were recruited into the study. The diagnosis of ICP was based on the symptoms, clinical examination and lab investigations. Group I: 25 women planned for delivery at POG 37 - 37+6 weeks of pregnancy. Group II: 25 women Planned for delivery at POG ≥38 weeks of pregnancy.
Results: In group, one woman had preterm delivery at POG 36+2 weeks and rest of 24 women were delivered at POG 37-37+6 weeks. In group II, out of 25 women one woman had emergency LSCS at POG 35+3 weeks for MSL and induction of labour was done in 2nd for abnormal fetal well-being tests at POG 37 weeks. One woman had pre-term delivery at POG 36+1 weeks. Remaining 22 women in group II were delivered at POG ≥38 weeks. In the present study there was no significant difference in the gestational age at delivery between the two groups.
Conclusions: It can be concluded that pregnancies with obstetric cholestasis can be carried to later gestation of ≥38 weeks under surveillance with UDCA treatment.
Metrics
References
Royal College of Obstetricians and Gynaecologists. Obstetric cholestasis. Green-top Guidelines 43. Issued: April 2011. https://rcog.org.uk /globalassats/ documents/ guidelines /gtg 43. Accessed 15April 2015.
Reyes H, Gonzalez MC, Ribalta J, Aburto H, Matus C, Schramm G, et al. Prevalence of intrahepatic cholestasis of pregnancy in Chile. Ann Intern Med. 1978;88:487-93.
Reyes H. Sex hormones and bile acids in intrahepatic cholestasis of pregnancy. Hepatol. 2008;47:376-9.
Abedin P, Weaver JB, Eggington E. Intrahepatic cholestasis of pregnancy: prevalence and ethnic distribution. Ethnic Health. 1999;4:35-7.
Kondrackiene J, Kupcinskas L. Intrahepatic cholestasis of pregnancy- current achievements and unsolved problems. World J Gastroenterol. 2006;14(38):5781-8.
Campos GA, Guerra FA, Israel EJ. Effects of cholic acid infusion in fetal lambs. Acta Obstet Gynecol Scand. 1986;65:23-6.
Williamson C, Gorelik J, Eaton BM, Lab M, de Swiet M, Korchev Y. The bile acid taurocholate impairs rat cardiomyo-cyte function: A proposed mechanism for intrauterine fetal death in obstetric cholestasis. Clin Sci (Colch). 2001;100:363-9.
Sepulvida WH, Gonalez C, Cruz MA, Rudolph MI. Vasocon-strictive effect of bile acids on isolated human placental chorionic veins. Eur J Obstet Gynecol Reprod Biol. 1991;42:211-5.
Davidson KM. Intahepatic cholestasis of pregnancy. Semin Perinatol. 1998;22:104-11.
Strehlow SL, Pathak B, Goodwin TM. The mechanical PR interval in fetuses of women with intrahepatic cholestasis of pregnancy. Am J Obstet Gynecol. 2010;203(5):455.
Gorelik J, Patel P, Ngandwe C. Genes encoding bile acid, phospholipid and anion transporters are expressed in a human fetal cardiomyocytes culture. BJOG. 2006;113:552.
Shaw D, Frohlich J, Wittmann BA, Willms M. A prospective study of 18 patients with cholestasis of pregnancy. Am J Obstet Gynecol. 1982;14:621-5.
Reid R, Ivey KJ, Rencoret RH, Storey B. Fetal complications of obstetric cholestasis. Br Med J. 1976;1:870-2.
Fisk NM, Storey GN. Fetal outcome in obstetric cholestasis. Br J Obstet Gynaecol. 1988;95:1137-43.
Roncaglia N, Arreghini A, Locatelli A, Bellini P, Andreotti C, Ghidini A. Obstetrics cholestasis: Outcome with active management. Eur J Osetet Gynecol Reprod Biol. 2002;100(2):167-70.
Davies MH, Dasilva RC, Jones SR, Weaver JB, Elias E. Fetal mortality associated with cholestasis of pregnancy and the potential benefit of therapy with ursodeoxycholic acid. Gut. 1995;37:580-4.
Zecca E, Costa S, Lauriola V, Vento G, Papacci P, Romagnoli C. Bile acid pneumonia: a "new" form of neonatal respiratory distress syndrome. Pediatr. 2004;114:269-72.
Jain R, Suri V, Chopra S, Chawla YK, Kohli KK. Obstetrics cholestasis: Outcome with active management. J obstet Gynaecol. 2013;39(5):953-9.
Sharma N, Panda S, Singh AS. Obstetric outcome during an era of active management for obstetric cholestasis. J Obstel Gynecol India. 2016;66(S1):S38-4.
Yerebasmaz N, Esinler D, Aldemir O, Ilgm H, Kandemir O, Yalvac S. Intrahepatic cholestasis of pregnancy: Perinatal outcome from a tertiary referral hospital in Turkey. Inter J Current Adv Res. 2016;5(3):689-93.
Dodampahala SH, Pieris H, Chandrasena LG, Jayakody S, Gunathilaka C, Wijayaratne CN, et al. Presence of Obstetrics Cholestasis in Mothers Presenting with Pruritus in Pregnancy: In a Low Resource South Asian Setting. AR Sci. 2016;4:3745.
Bacq Y, Sapey T, Brechot MC, Pierre F, Fignon A, Dubios F. Intrahepatic cholestasis of pregnancy: A French prospective study. Hepatol. 1997;26:358-64.
Pata O, Vardareli E, Ozcan A, Serteser M, Unsal I, Saruc M, et al. Intrahepatic cholestasis of pregnancy: correlation of preterm delivery with bile acid. Turk J Gastroenterol. 2011;22(6):602-5.
Wikstrom SE, Marschall HU, Ludvigsson JF, Stephansson O. Intrahepatic cholestasis of pregnancy and associated adverse pregnancy and fetal outcomes: a 12-year population-based cohort study. BJOG. 2013;120:717-72.