A CLINICAL AUDIT OF INTRAHEPATIC CHOLESTASIS OF PREGNANCY AND OUTCOMES IN INDIA 

DR ARBINDER DANG      MD DNB MNAMS FRCOG UK   

SENIOR CONSULTANT OBGYN    SANT PARMANAND HOSPITAL CIVIL LINES DELHI   INDIA 

AIM: A clinical audit to study the maternal and perinatal outcomes in ICP in a tertiary-level hospital in India.

INTRODUCTION: Intrahepatic cholestasis of pregnancy (ICP) is a medical condition in pregnancy. The main risk is stillbirth.   Diagnostic criteria include Pruritus, serum bile acid (SBA) ≥10 µmol/L, Alanine transaminase (ALT) Serum glutamate pyruvate transaminase (SGPT) >30 U/l.

MATERIAL & METHODS: 

INCLUSION CRITERIA: Pruritus, elevated liver transaminases, elevated serum peak bile acids,  singleton pregnancy

EXCLUSION CRITERIA:  Prior liver disorder, Hepatotoxic drug intake, Multiple pregnancy

Maternal and perinatal outcomes were studied. Serum Bile acids were done in a non-fasting state. All patients were treated with UDCA. Data was analysed on X cel sheet.

RESULTS:  Prevalence of ICP in our study was 7.08% (206 /2907). 

CONCLUSION: The incidence of ICP is high in our cohort of women. The gestational age of diagnosis of ICP was early 32 weeks. The incidence of gestational Diabetes and postpartum hemorrhage was high. All women were treated with UDCA, and it helped in reducing adverse maternal and perinatal outcomes. Compliance with serum Bile Acids after elevated transaminases to formulate a correct diagnosis of ICP is essential. Elevated Serum Bile Acids had a significant correlation with elevated SGPT  (Alanine transaminase ALT ). Incidence of Preterm birth, pregnancy-induced hypertension, meconium, and adverse fetal outcomes. Intrauterine growth restriction and stillbirths were high as the severity of ICP increased. All Stillbirths were in the severe ICP group.

Recommended to screen all pregnant women in our population for liver function tests at 28 and 32 weeks and bile acids testing if high, as the prevalence of ICP in our population is high.

Reaudit after recommendations are put into practice.