Abstract

Maternal physiology undergoes a number of transient and persistent changes throughout pregnancy. Nearly all maternal tissues change in some way during pregnancy.The prevalence of IHCP varies significantly across all ethnic groups. In the world, 0.2–2% of pregnant women experience it. Increased risks of post-partum haemorrhage, LSCS, severe pruritus with dyslipidemia, altered coagulation profile, and premature prelabour rupture of membrane are some of the complications associated to IHCP, so this study was conducted with an aim to assess the incidence of intra hepatic cholestasis among pregnant women and to assess the feto-maternal outcome pregnancy complicated by intra hepatic cholestasis.
Methods: After receiving approval from the research and ethical committee of the institute, this hospital-based prospective study was carried out among pregnant women with a diagnosis of intra hepatic cholestasis who were recruited over a period of 2 years in the department of Obstetrics and Gynaecology. A complete hemogram, liver function tests (total and conjugated serum bilirubin), aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (AP), serum bile acids, urine routine, and microscopy test were performed on all patients. Ursodeoxycholic acid (UDCA) 10-15 mg/kg/day, with a maximum dose of 300 mg 8 hours a day, was indicated for oral administration to all confirmed patients of IHCP.
Results: The incidence of Intra Hepatic cholestasis among pregnant women was 3.88%.The mean age of pregnant women was 27.11±5.82 years. Around two third of pregnant women (69.0%) were diagnosed with Intra Hepatic cholestasis between 33-36 weeks of gestational age.Three fourth of the pregnant women with Intra Hepatic cholestasis had deranged total bilirubin (76.8%), Aspartate Aminotransferase (79.8%), and Alanine Aminotransferase (73.2%).The Pre-eclampsia and Postpartum haemorrhage were observed as complications among 22.0% and 14.3% of pregnant women with Intra Hepatic cholestasis respectively. The Apgar score at 1 minute and at 5 minutes was <7 in 12.5% and 8.3% of neonates born to pregnant women with Intra Hepatic cholestasis respectively.
Conclusion: Hepatic dysfunction in pregnancy is typically caused by intrahepatic cholestasis. In terms of higher incidence of lower segment caesarean sections and discomfort from pruritus, maternal morbidity has increased