NEONATAL OUTCOME IN OBSTETRIC CHOLESTASIS PATIENTS AT AYUB TEACHING HOSPITAL ABBOTTABAD

Authors

  • Ruqqia Sultana
  • Irum Sarwar
  • Ali Fawad
  • Shehla Noor
  • Rubina Bashir

Abstract

Background: Obstetric cholestasis is a liver disease specific to pregnancy characterised by pruritusaffecting the whole body but particularly the palms and soles and abnormal liver function tests.Objective of this cross sectional study was to evaluate obstetric cholestasis as a potential risk factorfor adverse neonatal outcome. The study was conducted at Department of Obstetrics andGynaecology, Unit ‘B’, Ayub Teaching Hospital, Abbottabad from April 1, 2007 to March 31, 2008.Methods: All patients presenting with obstetric cholestasis irrespective of their age and parity wereincluded in the study. Patients presenting with other causes of pruritus during pregnancy likeHepatitis (A, B, C), eczema, pruritus gravidarum and herpes gestationes were excluded from thestudy. Patients with liver involvement due to pre-eclampsia were also excluded. Baselineinvestigations, liver chemistries, viral screening, liver autoimmune screen, liver and obstetricalultrasound were all done before the diagnosis was confirmed. Patients were treated symptomatically.Neonatal outcome was calculated in terms of increased incidence of passage of meconium, pretermdelivery and foetal distress requiring delivery by Caesarean-Section. Results: Thirty patients wereselected. Babies of 10 patients did well after delivery, 8 required NICU care within first 24 hours ofbirth and rest were delivered with low APGAR score. Two babies were delivered stillborn.Conclusion: Pruritus is quite common in pregnancy with obstetric cholestasis being one of them andearlier detection of the disease allows better identification of foetuses at risk.Keywords: Hepatic cholestasis, Pruritus, liver Function Tests, Foetal distress.

References

Kenyon AP, Girling J, Nelson- Piercy C, Williamson C, Seed

PT, Poston L, et al. Pruritus in pregnancy and the

identification of obstetric cholestasis risk: a prospective

prevalence study of 6531 women. J Obstet Gynaecol 2002;22

Suppl 1:S15.

Abedin P, Weaver JB, Eggintin E. Intrahepatic cholestasis of

pregnancy: prevalence and ethnic distribution. Ethn Health.

;4:35–7.

Kenyon AP, Nelson- Piercy C, Girling J, Williamson C,

Tribe RM, Shennan AH. Obstetric cholestasis, outcome with

active management: a series of 70 cases. BJOG

;109:1M–7.

Kenyon AP, Nelson-Piercy C, Girling J, Williamson C, Tribe

RM, Shennan AH. Obstetric cholestasis, outcome with active

management: a series of 70 cases. BJOG 2002;109(3):282–8.

Bacq Y, Sapey T, Brechot MC, Pierre F, Fignon A, Dubois F.

Intrahepatic cholestasis of pregnancy: a French prospective

study. Hepatology 1997;26:358–64.

Reid R, Ivey K J, Rencoret R H, Storey B. Fetal

complications of obstetric cholestasis BMJ 1976;i:870–2.

Shaw D, Frohlich J, Wittman BAK, Willms M. A prospective

study of 18 patients with cholestasis of pregnancy. Am J

Obstet Gynecol 1982;142:621–5.

Breg B, Helm G, Pertersohm L, Trydong L. Cholestasis of

pregnancy. Acta Obstet Gynecol Scand 1986;65:107–13.

Fisk NM, Storey GNB. Fetal outcome in obstetric

cholestasis. Br J Obstet Gynaecol 1988;95:1137–43.

Rioseco AJ, Ivankovic MB, Manzur A, Hamed F, Kato Sr,

Parer JT, et al. Intrahepatic cholestasis of pregnancy-a

retrospective case-control study of perinatal outcome. Am J

Obstet Gynecol 1994;170:890–5.

Roncaglia N, Arreghini A, Locatelli A, Bellini P, Andreotti

C, Ghidini A. Obstetric cholestasis outcome with active

management. Eur J Obs Gyne Reprod Biol 2002;100:167–70.

Bacq Y, Sapey T, Brechot Mc, Pierre F, Fignon A, Dubois F.

Intrahepatic cholestasis of pregnancy: a French prospective

study. Hepatology 1997;26:358–64.

Gonzalez CG, Reyes H, Arrese M, Figueroa D, Lorca

B, Andresen M, et al. Intrahepatic cholestasis of pregnancy

in twin pregnancies. J Hepatol 1989;9:84–90.

Laatikainen T Ikonen E. Fetal prognosis in obstetric

hepatosis. Ann Chir Gynecol Fenniae 1975:64:155–64.

Locatelli A, Roncaglia N, Arreghini A, Bellini P, Vergani P,

Ghidini A. Hepatitis C virus infection is associated with a

higher incidence of cholestasis of pregnancy. Br J Obstet

Gynaecol 1999;106:498–500.

Reyes H. The spectrum of liver and gastrointestinal disease

seen in cholestasis of pregnancy. Gastroenterol Clin North

Am 1992;21:905–21.

Laatikainen T, Ikonen E. Serum bile acids in cholestasis of

pregnancy. Obstet Gynaecol 1977;50:313–8.

Lunzer M, Barnes P, Blyth K, O’Halloran M. Serum bile acid

concentrations during pregnancy and their relationship to

obstetric cholestasis. Gastroenterology 1986;91:825–9.

Zimmeqman P, Koshiken J, Vaalamo P, Ranta T. Doppler

umbilical artery velocimetry in pregnancies complicated by

intrahepatic cholestasis. J Perinat Med 1991;19:351–5.

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Published

2009-12-01

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