scholarly journals Maternal and fetal outcome in intrahepatic cholestasis of pregnancy at tertiary care institute of North India

2021 ◽  
Vol 0 ◽  
pp. 1-5
Author(s):  
Sunita Arora ◽  
Anju Huria ◽  
Poonam Goel ◽  
Jasbinder Kaur ◽  
Sunita Dubey
Keyword(s):  
Bile Acids ◽  
Intrahepatic Cholestasis ◽  
Liver Enzymes ◽  
Tertiary Care ◽  
Population History ◽  
Whole Body ◽  
Control Group ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Initial Visit ◽  
Cholestasis Of Pregnancy

Objectives: Intrahepatic cholestasis of pregnancy (IHCP) is the most common reversible form of hepatic disease in pregnancy. The risk of sudden intrauterine infant death is major threat as none of the fetal monitoring proved effective for its prevention. This study was conducted to know the prevalence of IHCP along with fetal and maternal outcome in North Indian population. Material and Methods: This case–control study was conducted over a period of 6 months. One hundred pregnant patients were recruited in each group. Patients with IHCP were included in case group whereas apparently healthy pregnant women with singleton pregnancy were included in control group. Bile acids were done only once at the time of initial visit whereas liver enzymes were done at initial visit and subsequently weekly for total 3 times. All cases of IHCP were started on ursodeoxycholic acid (UDCA) with a dose of 10–15 mg/kg/day throughout pregnancy and three doses of 10 mg Vitamin K by intramuscular route were also given. Fetal and maternal outcomes were compared between both the groups. Total numbers of deliveries in that time period were also noted to find out the prevalence of disease. The tests of two or more proportions were done using Fisher’s exact test and Chi-square test. P < 0.05 was considered statistically significant. Results: The prevalence of IHCP was 4.08% in our population, however, women from urban area had higher incidence of cholestasis than rural population. History of recurrent disease was found in 30% of women. Out of 100, 96% presented with itching and only 57–58% had raised liver enzymes levels. In 89% of patients (89/100), bile acids levels were >14 μmol/l. During follow-up, SGOT and SGPT levels were significantly improved over 2-week interval while on treatment with UDCA; however, levels were still on higher side. There was no correlation found between cholestasis of pregnancy with preterm labor and meconium-stained liquor in the present study. Comparable results were found in terms of respiratory distress syndrome and NICU admission, whereas significant high incidence of neonatal jaundice found in the control group. Conclusion: Itching over whole body was the predominant presenting complaints of cholestasis of pregnancy. Diagnosis should be supported by bile acids in women with normal liver enzymes to decrease the cost of investigations. Early termination of pregnancy between 36 and 37 weeks can be considered in women with bile acids >40 μmol/L and in non-compliant patients on UDCA treatment.

scholarly journals Intrahepatic cholestasis of pregnancy: maternal and fetal outcome and its correlation with serum bile acid levels

2018 ◽  
Vol 7 (11) ◽  
pp. 4403
Author(s):  
Bhawna Sharma ◽  
Neetu Arora ◽  
Kusum Dogra ◽  
Kamal S. Negi
Keyword(s):  
Bile Acid ◽  
Cesarean Delivery ◽  
Intrahepatic Cholestasis ◽  
Perinatal Death ◽  
Tertiary Care ◽  
Neonatal Outcomes ◽  
Serum Bile Acid ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Vaginal Deliveries ◽  
Cholestasis Of Pregnancy

Background: Maternal, fetal, and neonatal outcomes in parturients with intrahepatic cholestasis of pregnancy (ICP) have been retrospectively documented. We aimed to present pregnancy outcomes of parturients with ICP who underwent delivery. The study was conducted during a 1-year period in a tertiary care centre.Methods: Data from 1 January to 31 December 2017 were collected to identify parturients with ICP.Results: Almost 3/4th of births came to a vaginal delivery (76.74%) and only 10 parturients had cesarean delivery. 4 of 10 parturients underwent nonelective cesarean section, while 6 had elective cesarean delivery. 15.15 % vaginal deliveries were instrumental. The most common indications for emergency LSCS and instrumental deliveries was fetal distress followed by failure to progress of labour. Most births occurred at or after 37 weeks of gestation (65%).  Regarding neonatal outcomes in terms of birth weight and Apgar scores at 1 and 5 min, they were positive, as well.  None of the babies had Apgar score < 7 at 5 minutes. No case of perinatal death was observed.Conclusions: Although the results were generally positive, larger studies need to be conducted to evaluate the maternal and fetal outcomes in ICP and correlation with serum bile acid levels.

scholarly journals The comparison of total bile acid concentration and alcohol dehydrogenase activity as markers of intrahepatic cholestasis of pregnancy

2021 ◽  
Author(s):  
Wojciech Jelski ◽  
Joanna Piechota ◽  
Karolina Orywal ◽  
Barbara Mroczko
Keyword(s):  
Bile Acid ◽  
Alcohol Dehydrogenase ◽  
Bile Acids ◽  
Intrahepatic Cholestasis ◽  
Total Bile Acid ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Third Trimester ◽  
Total Bile Acids ◽  
Adh Activity ◽  
Cholestasis Of Pregnancy

Introduction: Intrahepatic cholestasis of pregnancy (ICP) is the liver disorder in the second or early third trimester of pregnancy. It is characterized by pruritus with increased serum bile acids concentration and other liver function tests. ICP  is connected with increased risk of fetal mortality, but is unfortunately detected quite late. Therefore, it is important to recognize the disease in its early stages. We aimed to investigate the serum alcohol dehydrogenase (ADH) activity and compare it with the concentration of total bile acid (TBA) in women with ICP. Methods: Serum samples were taken for routine investigation from 80 pregnancies with ICP in the second or third trimester of pregnancy and from 80 healthy pregnant women in the same time of pregnancy. For measurement of class I activity we used the spectrofluorometric methods. The total ADH activitiy was measured by the photometric method. Results: The analysis of results shows a statistically significant increase in the activity of ADH I and ADH total (about 60% and 41.3%, respectively). Activity of ADH I well correlated with aminotransferases (alanine ALT and aspartate AST) and total bile acids (TBA) concentration. The total ADH activity was also positively correlated with ALT, AST and total bile acids. Conclusion: We can state that the activity of class I alcohol dehydrogenase isoenzyme in the sera of patients with ICP is increased and seems to be a good indicator of liver cell destruction during this disease and is comparable with the value of other markers.

scholarly journals Obstetric Cholestasis: A Review and Update

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Olawumi Adaramodu ◽  
Anthony Kodzo-Grey Venyo
Keyword(s):  
Liver Function ◽  
Bile Acids ◽  
Intrahepatic Cholestasis ◽  
Liver Function Tests ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Third Trimester ◽  
Serum Bile Acids ◽  
Function Tests ◽  
Cholestasis Of Pregnancy ◽  
In Pregnancy

Obstetric cholestasis (OC) is a liver disorder that occurs in the late second and early third trimester of pregnancy characterized by pruritus with increased serum bile acids and other liver function tests. The pathophysiology of OC is still not completely understood. The symptoms and biochemical abnormality rapidly resolve after delivery. OC is associated with an increased risk of adverse obstetrical outcomes. The aetiology of obstetric cholestasis of pregnancy is poorly understood and is thought to be complicated and multifactorial.  OC typically occurs in the late second trimester when the oestrogen levels are the highest in pregnancy. The most common complaint is generalized intense pruritus, which usually starts after the 30th week of pregnancy. Pruritus can be more common in the palms and soles and is typically worse at night. Other symptoms of cholestasis, such as nausea, anorexia, fatigue, right upper quadrant pain, dark urine, and pale stool, can be present. Clinical jaundice is rare but may present in 14% to 25% of patients after 1 to 4 weeks of the onset of pruritus. Some patients also complain of insomnia as a result of pruritus. Generally, physical examination is unremarkable except for scratch marks on the skin from pruritus. Pruritus is a cardinal symptom of intra-hepatic cholestasis of pregnancy (ICP) and may precede biochemical abnormalities. The diagnosis of intrahepatic cholestasis of pregnancy is via the presence of clinical symptoms pruritus in the third trimester with elevated maternal total serum bile acids and excluding other diagnoses, which can cause similar symptoms and lab abnormalities. Fasting blood samples should be used to check for the total bile salt acid level as it can become elevated in the postprandial state. Once the diagnosis of OC of pregnancy is confirmed, immediate treatment is necessary, and the primary goal of therapy is to decrease the risk of perinatal morbidity and mortality and to alleviate maternal symptoms. Maternal pruritus can be alleviated with use of moisturisers and oral antihistamines. Ursodeoxycholic acid (UDCA) is the drug of choice for the treatment of ICP. Many authors have advocated elective early delivery of women with intrahepatic cholestasis of pregnancy to reduce the risk of sudden foetal death. The Royal College of Obstetricians and Gynaecologists recommends induction of labour after 37+0 weeks of gestation. Obstetric cholestasis of pregnancy is not an indication for Caesarean delivery. Postpartum pruritus typically disappears in the first 2 to 3 days following delivery, and serum bile acid concentrations will normalize eventually. ICP is not a contraindication to breastfeeding, and mothers with a history of ICP in pregnancy can breastfeed their infants. Postpartum monitoring and follow up of bile acids and liver function tests should be done in 4-6 weeks to ensure resolution. Women with the persistent abnormality of liver function test after 6 to 8 weeks require investigation for other aetiologies.

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

2016 ◽  
Vol 5 (1) ◽  
pp. 20-25 ◽  
Author(s):  
Sita Pokhrel Ghimire ◽  
Ashima Ghimire ◽  
Gauri Shankar Jha ◽  
Manisha Chhetry ◽  
Mahanand Kumar
Keyword(s):  
Intrahepatic Cholestasis ◽  
Tertiary Care ◽  
Fetal Distress ◽  
Liver Function Tests ◽  
Maternal Outcomes ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
Medical College ◽  
Cholestasis Of Pregnancy

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

Sign in / Sign up

Export Citation Format

Share Document