OBSTETRIC CHOLESTASIS IN PREGNANCY: EVALUATING FETOMATERNAL OUTCOMES

A IFTIKHAR; M RAEES; S YOUSAF

doi:10.54112/pjicm.v5i02.205

Authors

A IFTIKHAR Department of Obstetrics & Gynaecology, Qazi Hussain Ahmed Medical Complex Nowshera, Pakistan
M RAEES Department of Obstetrics & Gynaecology, Lady Reading Hospital, Peshawar, Pakistan
S YOUSAF Department of Obstetrics & Gynaecology, Khyber Teaching Hospital, Peshawar, Pakistan

DOI:

https://doi.org/10.54112/pjicm.v5i02.205

Keywords:

Obstetric Cholestasis, Intrahepatic Cholestasis of Pregnancy, Fetomaternal Outcomes, Emergency Caesarean Section, Meconium-Stained Liquor, Preterm Birth, Neonatal Intensive Care Unit

Abstract

Background: Obstetric cholestasis is a pregnancy-specific liver disorder characterized by pruritus and elevated serum bile acids. It is associated with significant maternal and fetal risks, including preterm birth, fetal distress, and increased cesarean delivery rates. Early identification is essential to reduce complications and improve outcomes. Objective: To evaluate fetomaternal outcomes among pregnant women diagnosed with obstetric cholestasis. Study Design: Descriptive cross-sectional study. Setting: Conducted at a tertiary care obstetrics unit. Duration of Study: From October 2024 to August 2025. Methods: A total of 118 pregnant women with obstetric cholestasis were included. Diagnosis was confirmed by pruritus and serum total bile acids >10 µmol/L. Maternal outcomes assessed included emergency cesarean section, postpartum hemorrhage, and gestational diabetes. Neonatal outcomes included meconium-stained liquor, preterm delivery, low birth weight, low Apgar scores, and NICU admission. Data were analyzed using SPSS version 25, and results were presented as frequencies, percentages, and means. Results: The mean maternal age was 26.86 ± 7.03 years. Emergency cesarean section occurred in 36.4% (n = 43). Postpartum hemorrhage was observed in 10.2% (n = 12), and gestational diabetes in 11.9% (n = 14). Among neonatal outcomes, meconium-stained liquor was present in 36.4% (n = 43), preterm delivery in 27.1% (n = 32), and low birth weight in 28.0% (n = 33). Low Apgar scores were recorded in 7.6% (n = 9), and 22.0% (n = 26) required admission to the NICU. Conclusion: Obstetric cholestasis was associated with an increased risk of adverse maternal and fetal outcomes. Early diagnosis, close monitoring, and timely intervention are essential to reduce complications and improve perinatal outcomes.

References

Chaudhary S, Anjum HH, Khan MU, Khurram A, Nazim U, Maqsood Dar M. A systematic review on complications of intrahepatic cholestasis of pregnancy. Pak J Med Health Sci. 2022;16(10):894-9. https://doi.org/10.53350/pjmhs221610894

Odutola PO, Olorunyomi PO, Olatawura OO, Olorunyomi I, Madojutimi O, Fatunsin AO, et al. Intrahepatic cholestasis of pregnancy is associated with increased risk of hepatobiliary disease and adverse fetal outcomes: a systematic review and meta-analysis. iLiver. 2023;2(4):219-26. https://doi.org/10.1016/j.iliver.2023.11.001

Mazhar T, Niaz H, Bukhari N. Maternal and perinatal outcomes in obstetric cholestasis: data of a tertiary care hospital. J Med Sci. 2022;30(2):126-30. https://doi.org/10.52764/jms.22.30.2.5

Hassan G, Inam I, Sajjad S. Pregnancy outcomes with intrahepatic cholestasis. Pak J Med Health Sci. 2022;16(5):216. https://doi.org/10.53350/pjmhs22165216

Hamdard SJ, Samad A, Khan F, Waleem N. Maternal and fetal outcome in pregnancy complicated by intrahepatic cholestasis of pregnancy. J Soc Obstet Gynaecol Pak. 2024;14(3):310-15.

Teng J, Bohlin K, Nemeth A, Fischler B. Cholestasis after very preterm birth was associated with adverse neonatal outcomes but no significant long-term liver disease: a population-based study. Acta Paediatr. 2021;110(1):141-8. https://doi.org/10.1111/apa.15362

Kawakita T, Parikh LI, Ramsey PS, Huang CC, Zeymo A, Fernandez M, et al. Predictors of adverse neonatal outcomes in intrahepatic cholestasis of pregnancy. Am J Obstet Gynecol. 2015;213(4):570.e1-8. https://doi.org/10.1016/j.ajog.2015.06.021

Rehman N, Aslam S, Siddique US, Jamil F, Khttab A. Fetomaternal outcome among pregnant women presented with obstetric cholestasis. Biol Clin Sci Res J. 2024;2024(1):1442. https://doi.org/10.54112/bcsrj.v2024i1.1442

Anwar R, Razzaq K, Noor N, Ansari A, Imran A. Impact of obstetric cholestasis on fetomaternal outcome. Pak Armed Forces Med J. 2022;72(Suppl 2):S379-83. https://doi.org/10.51253/pafmj.v72iSUPPL-2.4954

Nasir A, Muneer N, Butt A, Hameed S, Asif S, Rana MN. Fetomaternal outcomes in intrahepatic cholestasis of pregnancy at tertiary care hospital in Lahore. Natl J Health Sci. 2025;10(2):135-40. https://doi.org/10.21089/njhs.102.0135

Madhu M, Hansda R, Bharti A, Kumari P. Fetomaternal outcome in obstetric cholestasis in a tertiary care hospital. Ann Afr Med. 2025;0:0. https://doi.org/10.4103/aam.aam_100_25

Upreti P. Intrahepatic cholestasis of pregnancy and fetomaternal outcomes: a retrospective study from Uttarakhand, India. J South Asian Feder Obst Gynaecol. 2024;16(5):479-85. https://doi.org/10.5005/jp-journals-10006-2459

Singh T, Rasheed M, Nagaraja N, Jain C, Yazdani S. Intrahepatic cholestasis of pregnancy: adverse fetomaternal outcome. J Popul Ther Clin Pharmacol. 2024;31(4):1693-9. https://doi.org/10.53555/jptcp.v31i4.6007

Valdovinos-Bello V, García-Romero CS, Cervantes-Peredo A, García-Gómez E, Martínez-Ibarra A, Vázquez-Martínez ER, et al. Body mass index implications in intrahepatic cholestasis of pregnancy and placental histopathological alterations. Ann Hepatol. 2023;28(1):100879. https://doi.org/10.1016/j.aohep.2022.100879

Martineau M, Raker C, Powrie R, Williamson C. Intrahepatic cholestasis of pregnancy is associated with an increased risk of gestational diabetes. Eur J Obstet Gynecol Reprod Biol. 2014;176:80-5. https://doi.org/10.1016/j.ejogrb.2013.11.024

Mukhopadhyay AK, Mukhopadhyay M, Anjum N. Feto-maternal outcomes in intrahepatic cholestasis of pregnancy in a state teaching hospital. Eur J Cardiovasc Med. 2025;15(7):862-6.

Sridhar S, Tirkey R, Sanga AJ. To correlate maternal serum total bile acids and fetomaternal outcomes in obstetric cholestasis. Indian J Obstet Gynecol Res. 2025;12(3):487-94.