AN OBSERVATIONAL RESEARCH ON OBSTETRIC CHOLESTASIS AND ITS IMPACT ON FOETAL OUTCOME

Abstract

Background: Obstetric cholestasis (OC) is a hepatic disease distinctive to pregnancy which is classified as dermatoses of pregnancy with an initial presentation of pruritus. OC is different compared to the other dermatoses of pregnancy such that there are no lesions or primary rash but there is, however, a propensity for maternal morbidity and a substantial risk of morbidity and mortality of fetus, also there are implications about health of offspring in future. Increased foetal serum bile-acids viz. taurocholic and taurodeoxycholic acid are likely associated to foetal complications of Intra-hepatic cholestasis of pregnancy (ICP). It has been known that women suffering from OC have abnormal hormonal metabolism, genetic predisposition, altered immunity and they are subjected to environmental influences.

Aims & Objectives: To research the impact of obstetric cholestasis on foetal outcome.

Material & Methods: Patients who showed clinical symptoms of pruritus which was unidentified with other etiology along with elevated hepatic enzymes and who were presented between 30 to 40 weeks of gestation were identified as having clinical Obstetric cholestasis while few patients were excluded as they had other chronic hepatic disease or dermatological disease or choledocho-lithiasis and some of them had acute fatty hepatic of pregnancy.

Results: It was found that 20(40%) patients among 50 cases had bile-acid levels > 40 ?mol/l while 30(60%) patients belonged to the group having bile-acid levels < 40 ?mol/l. Among 20 cases in group 1, 18(90%) cases reported foetal complications which was very high compared to group 2 where among 30 cases only 4(13.3%) cases were found to have foetal complications. Among those 18 cases, majority of cases 10(55.6%) were observed to have respiratory distress followed by 4(22.2%) cases of low birth weight, 3(16.7%) cases with intrauterine foetal disease and 1(5.6%) still birth. While among 4 cases with bile-acid levels < 40 ?mol/l, 3(75%) had respiratory distress followed by 25(%) low birth weight cases. There was no case of IFD as well as still birth in group 2.

Conclusion: Our research shows that there is a substantial risk of foetal morbidity and mortality in OC with clear consequences for the offspring’s potential health. We also observed that in those with a higher bile-acid pool, most of the foetal complications occur. This indicates that bile-acid sensitivity can be used in OC as a predictive marker of foetal risk. This means that OC-affected pregnancies fall into the high-risk group and require foetal surveillance.

Keywords: obstetric cholestasis, foetal outcome, bile-acid levels, dermatoses, low birth weight