Perinatal complications in intrahepatic cholestasis of pregnancy
International Journal of Clinical Biochemistry and Research
and Objective: Intrahepatic cholestasis of pregnancy (ICP) is seen usually in 3 rd trimester of pregnancy. Overall incidence is 1.2-1.5% of Indian pregnant women. The biochemical abnormalities often include raised liver enzymes, conjugated bilirubin and bile acids. ICP can complicate perinatal outcomes to a significant extent. The present study was conducted to find out the types and incidence of perinatal outcomes in pregnancy complicated with ICP diagnosed by abnormal LFTS (liver function
... s), to help the clinician in initiating timely treatment. Materials and methods: In the present study, 51 pregnant women diagnosed with ICP and 49 number of age and gravida matched normal pregnant women were included as cases and controls respectively. LFT and Total bile acids were estimated by standard biochemical methods. Both cases and controls were followed to evaluate perinatal outcomes after 7 days of postpartum. Results: Total bilirubin (0.6 ± 0.08 Vs 0.4 ± 0.03)milligrams/decilitre*; Aspartate transaminases (48 ± 18.6 Vs 27 ± 9.5) International Units/ Litre**; Alanine transaminase (42 ± 14.2 Vs 28 ± 6.1) International Units/ Litre**; Alkaline phosphatase (251 ± 63 Vs 159 ± 58) International Units/ Litre**;Gamma glutamyl transferase (41 ± 5.2 Vs 35 ± 3.6) International Units/ Litre**; Total bile acids (12.7 ± 10.2 Vs 33.4 ± 15.6)µ mol/ Litre ; Albumin (3.3 ± 0.5 Vs 3.2 ± 0.4)grams/decilitre; Total Proteins(6.3 ± 1.2 Vs 6.1 ± 1.5)grams/decilitre were obtained in cases Vs controls. Significantly higher incidence of total complications in cases compared to controls(54.90% Vs 12.24%)*** were found which include respiratory distress(23.52 Vs 4.08)%***, meconium aspiration (9.80 Vs 2.04)%**, pre-term delivery (9.80 Vs 4.08)%*, hyperbilirubinemia (1.96 Vs 0.0)%, fetal bradycardia (7.84 Vs 2.04)%** and fetal loss(1.96 Vs 0.0)%. (*p value<0.05, **p value<0.01, ***p value ˂0.001) Conclusion: The present study found an increase in incidence of total morbidity and mortality during perinatal period in babies born to women suffering from ICP. These findings suggests estimation of total bile acids and liver enzymes for early diagnosis of pregnant women at risk, active monitoring, treatment and induction of labor around 36-38 weeks after establishment of lung maturity in pregnancy associated with ICP to prevent perinatal complications.