Obstetric Outcome During an Era of Active Management for Obstetrics Cholestasis.

Journal of obstetrics and gynaecology of India

PubMedID: 27651575

Sharma N, Panda S, Singh AS. Obstetric Outcome During an Era of Active Management for Obstetrics Cholestasis. J Obstet Gynaecol India. 2016;66(Suppl 1):38-41.
OBJECTIVE
To study the incidence, maternal, and perinatal outcomes in intrahepatic cholestasis of pregnancy with active management.

MATERIALS AND METHODS
This observational study included 48 cases diagnosed as intrahepatic cholestasis of pregnancy. Medical treatment and active management (fetal surveillance and termination of pregnancy at 37-38 weeks) were offered to all. Maternal and perinatal outcomes are studied.

RESULTS
Incidence of ICP was 2.4 %. More than 86 % of patients presented with generalized pruritus mostly after 30 weeks. Incidences of Intrapartum abnormal cardiotocography (12.5 %) and thick meconium (8.33 %) were high. Cesarean section rate was high (41.66 %). Most common indications were CDMR, fetal distress, and non-progress of labor. Incidence of preterm labor, IUGR, Apgar score (<7), and neonatal admission rate were not high. There was one stillbirth at 36 weeks of gestation. Serum transaminase levels tended to be higher in patients with poor perinatal outcomes, such as stillbirth, fetal distress, and meconium-stained amniotic fluid.

CONCLUSION
Serum transaminase levels tended to be higher in patients with poor perinatal outcome. Perinatal outcome is good with active management, at the cost of higher LSCS rate. Further randomized controlled trial of early versus spontaneous delivery may be justified.