Tayaba Mazhar, Hina Niaz, Naila Bukhari.
Maternal and Perinatal Outcomes in Obstetric Cholestasis - Data of a Tertiary Care Hospital.
J Med Sci Jan ;30(2):126-30.

Objective: To find out the maternal and perinatal outcome of intrahepatic cholestasis of pregnancy.Material and Methods: The study was conducted in the Gynae and Obstetric department of Khyber Teaching Hospital Pesha-war, Pakistan. This was a retrospective data review extending over two years period (from March 2018 to March 2020). Ante-natal patients having clinical and investigative findings suggestive of intrahepatic cholestasis were enrolled in the study. With a sample size of 82, patients having cholestasis due to other pathologies were excluded. Outcome measures were mean age, mean parity, and mean gestational age at diagnosis and at delivery. Type of labor, whether induced or spontaneous, mode of delivery, and indications of cesarean delivery were observed. Maternal and perinatal complications encountered like post-partum hemorrhage, preterm labor, intrauterine growth restriction, meconium aspiration, nursery, and neonatal intensive care unit admissions were noted.Results: Mean age was 29.6+-4.64, mean parity 2.8+-1.68, while the mean period of gestation at diagnosis 33.46+-2.67, and the mean period of gestation (POG) at delivery 37.6+-2.56. Patients who delivered vaginaly were 59 (71.91%) and via cesarean delivery were 23 (28.09%). Out of 23 patients who had cesarean delivery main indications were fetal distress in 11 patients, meconium-stained liquor (MSL) found in 16(19.51%) patients, preterm labor in 3(3.65%), and preterm premature rupture of membranes (PPROM) in 3 (3.65%). Primary postpartum hemorrhage (PPH) was observed in 4(4.87%). Babies born with Apgar score less than 7 were 12(14.65%) and those admitted in nursery and NICU were 14(17%).Conclusion: Intrahepatic cholestasis of pregnancy has a significant association with perinatal morbidity and mortality. The study found MSL in 16(19.51%) cases and fetal distress encountered in 13(15.85%) cases. 14(16.27%) newborns got ad-mitted to nurseries and NICU. Close monitoring in the antenatal period and induction of labour at 37- 38 weeks improve the perinatal outcomes.

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