Maternal outcome in cholestasis of pregnancy in patients attending a tertiary care hospital in north India

Introduction: Cholestasis of pregnancy is also known as jaundice of pregnancy, intrahepatic cholestasis of pregnancy, obstetric cholestasis or prurigo gravidarum. The condition manifests clinically in second or third trimester with generalised pruritus. Although maternal outcome is invariably good an increased fetal risk has been reported, namely preterm delivery, low birth weight babies, bradycardia, meconium staining of amniotic fluid, fetal distress, intrauterine death of fetus and increased perinatal mortality. All women should be closely monitored during the third trimester, especially, in case of twin pregnancy, if the onset of intrahepatic cholestasis is before 32 weeks of gestation, or with history of previous stillbirth. Objective: To determine maternal outcome in cholestasis of pregnancy. Methodology: This study was conducted in the depaerment of obstetrics and gynaecology.150 patients were enrolled from the outpatient department as well as from those admitted in the labour room with the history of intrahepatic cholestasis of pregnancy. Results: On analysis of data, mean gestational age at delivery was 38.14 weeks. About 75% patients delivered at term, whereas 10% had preterm delivery. 51% patients had spontaneous onset of labour and in 39% patients induction was done by different methods depending on the Bishop’s score. 59.3%patients had vaginal delivery, LSCS rate was 40.0% and instrumental delivery rate was .7%. High LSCS rate was because of meconium, fetal distress and previous LSCS. Intrapartum complications were present in 48.67% patients in the form of meconium staining of amniotic fluid in 24.67% patients, preterm delivery in 10% patients, fetal distress in 8.7% patients. Post partum complications were noted in 8% patients in the form of PPH (7.3%) and hematoma in (.7%). Conclusion: Cholestasis of pregnancy causes maternal pruritus with impaired liver function tests and raised serum bile acids. Maternal morbidity is increased in terms of increased LSCS rates and discomfort due to pruritus. A timely intervention at 37-38 weeks will reduce the adverse perinatal outcome.