DIAGNOSIS AND NEONATAL OUTCOME IN OBSTETRIC CHOLESTASIS
Keywords:
Gestational Cholestasis, Pruritis, Liver function test, Foetal OutcomeAbstract
Background: Gestational cholestasis can cause preterm delivery, meconium staining of liquor, foetal distress, intrauterine foetal death, Respiratory Distress Syndrome and NICU admission. Fetomaternal surveillance can be done by serial assessments of serum bile acid (SBA) levels, liver function tests, foetal kick count chart, foetal cardio-tocography and serial ultrasound assessments along with routine antinatal care. This retrospective study was conducted to find alternative methods of foetal surveillance in case of non availability of SBA assessment. Method: This study was conducted at AERO Hospital, Hasanabdal from Jan 2013 to Jul 2015, and 69 patients aged 18–40 years with gestational cholestasis and singleton pregnancy after excluding other causes of pruritis and deranged liver function tests were included in study and above mentioned parameters assessed. All patients were administered Ursodeoxycholic acid and Dexamethasone 12 mg, two doses 12 hours apart. Results: Twenty-five percent patients underwent preterm delivery, 25% had meconium stained liquor, 2.8% had intrauterine death, and 1.4% had early neonatal death. Greater the grade of pruritis and higher the abnormality of ALT were, the higher the incidence of foetal complication was. Conclusion: Pregnancies with getational cholestasis monitored in this way have reasonably good foetal outcome even in the absence of SBA monitoring but required more frequent visits by mothers and vigilance of obstetrician.
Paj J Physiol 2016;12(1):15–7
Downloads
References
2. Sebiha D, Yasin C, Orhan VO, Sule Y. Review of a challenging clinical issue: intrhepatic cholestasis if pregnancy. World J Gastroenterol 2015;21(23):7134–41.
3. Zecca E, De Luca D, Marras M, Caruso A, Bernardini T, Romagnoli C. Intrahepatic cholestasis of pregnancy and neonatal respiratory distress syndrome. Pediatrics 2006;117(5):1669–72.
4. RCOG Green top Guideline No 43. Obstetric Cholestasis. Royal College of Obstetricians and Gynecologists UK;2011.
5. Girling JC, Dow E, Smith JH. Liver function tests in pre-eclampsia–Importance of compassion with reference range derived from normal pregnancy. Br J Obstet Gynaecol 1997;104:204–50.
6. Manuela M, Mario C, Silvia L, Mario B, Vaperia T. In search of an accurate evaluation of intrahepatic cholestasis of pregnancy. Hindawi 2012, Article ID 496489, 6 pages. Available from: www.hindawi.com/journals/scientifica/2012/496489/
7. Ruqqia S, Irum S, Ali F, Shehla N, Rubina B. Neonatal outcome in obstetric cholestasis patients at Ayub Teaching Hospital Abbottabad. J Ayub Med Coll Abbottabad 2009;21(4):76–8.
8. Bacq Y. Sapey T, Brechot Mc, Pierre F, Fignon A, Dubois F. Intraepatic cholestasis of pregnancy: A French prospective study. Hepatol 1997;26:358–64.
9. Obstetrics and Midwifery Guideline No 2.18. Cholestasis in Pregnancy. Women and Newborn Health Services. King Edward Memorial Hospital;2008.
10. Gonzalez MC, Reyes H, Arrese M, Figueroa D, Lorca B, Andresen M, et al. Intra hepatic cholestasis of pregnancy in twin pregnancies. J Hepatol 1989;9:84–90.
11. Laatikainen T, Ikonen E. Foetal prognosis in obstetric hepatosis. Ann Chir Gynecol Fenn 1975;64(3):155–64.
12. Hagit B, Nir M, Gldeon K. Pruritis in pregnancy: Treatment of dermatoses unique to pregnancy. Can Fam Physician 2013;59(12):1290–4.
13. Phan NQ, Blome C, Fritz F, Gerss J, Reich A, Ebata T, et al. Assessment of pruritis intensity: Prospective study on validity and reliability of visual analogue scale, numerical rating scale and verbal rating scale in 471 patients with chronic pruritis. Acta Derm Venerol 2012;92(5):502–7.
14. Adam R, Jacek C, Szepietowski. Pruritis intensity assessment and challenge for clinicians. Expert Rev Dermatol 2013;8(3):291–9.
15. Sangita G, Soumik C. Intrahepatic cholestasis of pregnancy: A comprehensive review. Ind J Dermatol 2013;58(4):327.
Downloads
Published
How to Cite
Issue
Section
License
Pakistan Journal of Physiology, Pak J Physiol, PJP is FREE for research and academic purposes. It can be freely downloaded and stored, printed, presented, cited and quoted with full reference of, and acknowledgement to the PJP.
