Obstetric outcome of elevated total serum bile acid levels in women with intrahepatic cholestasis of pregnancy

Background: Intrahepatic cholestasis of pregnancy (IHCP) is a hepatic disorder associated specifically with pregnancy.It is found to affect both mother and fetus.It requires detailed clinical and biochemical evaluation for optimal feto-maternal outcome.Objectives: To study the demographic profile, clinical features and obstetric outcome in patients with intrahepatic cholestasis of pregnancy and to assess correlation between serum bile acid levels and perinatal outcome.Material and methods: This was a prospective study conducted on 150 pregnant women with IHCP who delivered at our tertiary care centre, Shri Mahant Indiresh Hospital, Dehradun from September 2018 -June 2020.The relationship between serum bile acid levels and fetal complications was analysed with binary logistic regression method.Results: The incidence of IHCP at our centre was found to be 2.82%.We found that 59.94% patients had bile acid levels between 10-40 µmol/L, 36.6% patients bile acid levels between 41-100 µmol/L and 3.33% patients had bile acid levels >100 µmol/L.The correlation between serum bile acid levels with onset of labour and mode of delivery was not statistically significant (p-value 0.16 and 0.556 respectively).The correlation between serum bile acid levels with meconium stained liquor, NICU admission and prematurity was found to be statistically significant with p-value of <0.001, 0.007 and 0.018 respectively.Conclusion: Symptomatic women should be subjected to estimation of serum bile acid levels so that appropriate treatment and timely intervention can be done to optimize obstetric outcome.