Obstetric outcome of elevated total serum bile acid levels in women with intrahepatic cholestasis of pregnancy

Abstract

Background: Intrahepatic cholestasis of pregnancy (IHCP) is a hepatic disorder associated specifically with pregnancy. It is found to affect both mother and fetus. It requires detailed clinical and biochemical evaluation for optimal feto-maternal outcome. Objectives: To study the demographic profile, clinical features and obstetric outcome in patients with intrahepatic cholestasis of pregnancy and to assess correlation between serum bile acid levels and perinatal outcome. Material and methods: This was a prospective study conducted on 150 pregnant women with IHCP who delivered at our tertiary care centre, Shri Mahant Indiresh Hospital, Dehradun from September 2018 – June 2020. The relationship between serum bile acid levels and fetal complications was analysed with binary logistic regression method. Results: The incidence of IHCP at our centre was found to be 2.82%. We found that 59.94% patients had bile acid levels between 10-40 µmol/L, 36.6% patients bile acid levels between 41-100 µmol/L and 3.33% patients had bile acid levels >100 µmol/L. The correlation between serum bile acid levels with onset of labour and mode of delivery was not statistically significant (p-value 0.16 and 0.556 respectively). The correlation between serum bile acid levels with meconium stained liquor, NICU admission and prematurity was found to be statistically significant with p-value of <0.001, 0.007 and 0.018 respectively. Conclusion: Symptomatic women should be subjected to estimation of serum bile acid levels so that appropriate treatment and timely intervention can be done to optimize obstetric outcome.

Keywords

• intrahepatic cholestasis of pregnancy
• pruritis
• serum bile acids
• meconium stained liquor
• ursodeoxycholic acid