MATERNAL AND PERINATAL OUTCOMES IN OBSTETRIC CHOLESTASIS – DATA OF A TERTIARY CARE HOSPITAL
DOI:
https://doi.org/10.52764/jms.22.30.2.5Abstract
ABSTRACT
Objective
To find out the maternal and perinatal outcome of intrahepatic cholestasis of pregnancy.
Material and Methods
This study was conducted in Gynae Obs unit of Khyber teaching hospital Peshawar. It is a retrospective observational hospital based study of two years from march 2018 to march 2020. All pregnant patients having symptoms suggestive of obstetric cholestasis which was confirmed by examination and lab investigations were enrolled in the study. Sample size was 82. Patients with cholestasis due to other pathologies were excluded. Outcome measures were mean age, mean parity, mean gestational age at diagnosis and at delivery. Whether labour was induced or spontaneous. Mode of delivery whether vaginal or operative and indications of caesarean delivery. Maternal and fetal complications encountered like post-partum hemorrhage, preterm labour, intrauterine growth restriction, meconium aspiration. Nursery and neonatal ICU admissions were also noted.
Results
Mean age was 29.6+_4.64, mean parity 2.8+_1.68, mean period of gestation at diagnosis 33.46+_2.67, mean POG at delivery 37.6+_2.56. Patients who delivered vaginaly were 59 (71.91%) and via cesarean delivery were 23(28.09%). Out of 23 patients who had cesarean delivery main indication was fetal distress in 11 patients. MSL found in 16(19.51%) patients, preterm labour in 3(3.65%), PPROM 3(3.65%), primary PPH 4(4.87%). Babies born with Apgar score less than 7 were 12(14.65%) and those admitted in nursery and NICU were 14(17%).
Conclusion
Intrahepatic cholestasis of pregnancy is associated with increased perinatal morbidity and mortality. In our study MSL found in 16(19.51%) cases and fetal distress encountered in 13(15.85%) cases. 14(16.27%) newborns got admitted in nursery neonatal ICU. Close monitoring in the antenatal period and induction of labour at 37- 38 weeks can improve the perinatal outcome. Various studies advocate delivery at 38 weeks of gestation except in cases of deranged liver biochemical parameters where early delivery is advised.
Keywords
Obstetric Cholestasis, Intrahepatic Cholestasis of Pregnancy, Bile acids, Liver Function Test.
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