1Assistant Professor, Department of Biochemistry, SCB Medical College, Cuttack, Odisha, India
2O & G Specialist, Department of O & G, VSS Medical College, Burla, Odisha, India
3Professor & HOD, Department of Biochemistry, SCB Medical College, Cuttack, Odisha, India
42nd Year PG, Department of Biochemistry, SCB Medical College, Cuttack, Odisha, India
*Corresponding author: E-mail: dranuva@gmail.com
Online published on 22 June, 2016.
Intrahepatic cholestasis of pregnancy (ICP) is seen usually in 3rd trimester of pregnancy. Overall incidence is 1.2–1.5% of Indian pregnant women. The biochemical abnormalities often include raised liver enzymes, conjugated bilirubin and bile acids. ICP can complicate perinatal outcomes to a significant extent. The present study was conducted to find out the types and incidence of perinatal outcomes in pregnancy complicated with ICP diagnosed by abnormal LFTS (liver function tests), to help the clinician in initiating timely treatment.
In the present study, 51 pregnant women diagnosed with ICP and 49 number of age and gravida matched normal pregnant women were included as cases and controls respectively. LFT and Total bile acids were estimated by standard biochemical methods. Both cases and controls were followed to evaluate perinatal outcomes after 7 days of postpartum.
Total bilirubin (0.6 ± 0.08 Vs 0.4 ± 0.03)milligrams/decilitre*; Aspartate transaminases (48 ± 18.6 Vs 27 ± 9.5) International Units/Litre**; Alanine transaminase (42 ± 14.2 Vs 28 ± 6.1) International Units/Litre**; Alkaline phosphatase (251 ± 63 Vs 159 ± 58) International Units/Litre**; Gamma glutamyl transferase (41 ± 5.2 Vs 35 ± 3.6) International Units/Litre**; Total bile acids (12.7 ± 10.2 Vs 33.4 ± 15.6)μ mol/Litre; Albumin (3.3 ± 0.5 Vs 3.2 ± 0.4)grams/decilitre; Total Proteins(6.3 ± 1.2 Vs 6.1 ± 1.5)grams/decilitre were obtained in cases Vs controls. Significantly higher incidence of total complications in cases compared to controls(54.90% Vs 12.24%)*** were found which include respiratory distress(23.52 Vs 4.08)%***, meconium aspiration (9.80 Vs 2.04)%**, pre-term delivery (9.80 Vs 4.08)%*, hyperbilirubinemia (1.96 Vs 0.0)%, fetal bradycardia (7.84 Vs 2.04)%** and fetal loss(1.96 Vs 0.0)%. (*p value<0.05, **p value<0.01, ***p value <0.001)
The present study found an increase in incidence of total morbidity and mortality during perinatal period in babies born to women suffering from ICP. These findings suggests estimation of total bile acids and liver enzymes for early diagnosis of pregnant women at risk, active monitoring, treatment and induction of labor around 36–38 weeks after establishment of lung maturity in pregnancy associated with ICP to prevent perinatal complications.
ICP, Total bile acids, LFT, Perinatal complications
