A Prospective Observational Study of Feto-Maternal Outcome in Patients Presenting with Intrahepatic Cholestasis of Pregnancy

Background; Intrahepatic cholestasis of pregnancy is a pregnancy-specific liver disorder characterized by pruritus and elevated serum bile acid levels, primarily occurring in the third trimester. ICP is associated with significant maternal morbidity and adverse fetal outcomes, including preterm birth, low birth weight, fetal distress, and intrauterine fetal demise. Data from rural populations remain limited. This study aimed to evaluate maternal and fetal outcomes in patients diagnosed with ICP in a tertiary care rural hospital.

Methods; This prospective observational study was conducted in the Department of Obstetrics and Gynaecology at Burdwan Medical College & Hospital from June 2023 to December 2024. A total of 100 pregnant women (34 weeks gestation to delivery) with confirmed ICP (Intrahepatic Cholestasis of Pregnancy) (serum bile acid ≥10 µmol/L) were enrolled. Patients with other hepatic disorders were excluded. Maternal complications, mode of delivery, laboratory parameters, neonatal outcomes, APGAR scores, birth weight, and SNCU admissions were recorded. Statistical analysis was performed using SPSS version 23, with p < 0.05 considered significant.

Results; Among 100 patients, 77% had no maternal complications, while 16% developed postpartum haemorrhage and 7% developed disseminated intravascular coagulation. Sixty percent underwent induced vaginal delivery and 24% required caesarean section. The mean bile acid level was 68.54 µmol/L. Elevated bile acid, SGPT, SGOT, and bilirubin levels were significantly associated with maternal complications (p ≤ 0.05). Neonatal mean birth weight was 2.727 kg. 41% of neonates required SNCU admission. Significant associations with SNCU admission (p < 0.001) were found for lower gestational age, elevated maternal bile acid levels, abnormal liver enzymes, lower birth weight, and low APGAR scores.

Conclusion; ICP is associated with significant maternal and neonatal morbidity, particularly in rural settings. Elevated bile acid and liver enzyme levels strongly predict adverse outcomes. Early diagnosis, close monitoring, and timely intervention are crucial to improving feto-maternal outcomes