Factors associated with obstetric cholestasis in a tertiary hospital in Nepal: A case control study
DOI:
https://doi.org/10.62992/7njv2z52Keywords:
Fetal complications, Maternal complications, Obstetric cholestasisAbstract
Background: Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disorder in pregnancy and is associated with an increased risk of adverse obstetrical outcomes like sudden fetal demise. It frequently develops in third trimester in pregnancy. It commonly occurs in individuals who are genetically predisposed. It is characterized by generalized itching, with no other skin manifestations. Maternal outcomes for patients diagnosed with ICP mild however, fetal outcomes are serious.
Objectives: To evaluate pregnancy outcomes and fetal complications associated with women with Obstetric cholestasis.
Methods: A retrospective case control study was conducted among women with Obstetric Cholestasis in Dhulikhel hospital in Nepal from April 2022 to April 2023. All the patients in the obstetrics and gynaecology labour room (Dhulikhel Hospital) with the diagnosis of Obstetric cholestasis in a given time frame were included. Secondary research data such as existing medical records and database were used for this study. Odds Ratio and its 95% CI was calculated by using unconditional logistic regression. P-value of <0.05 was considered as significant.
Results: The incidence of ICP was 4.2%. Majority of women with obstetric cholestasis belonged to age group 26-30 years. Majority of them were primigravida. This study identified that maternal and fetal complications were higher in women with obstetric cholestasis. The complications like Primary Postpartum Haemorrhage (PPH) (OR=2.43, 95%CI:1.03-5.76, p 0.042), meconium stained liquor (OR=4.44, 95%CI:2.26-8.72, p <0.001), abnormal Cardiotocography (CTG) (OR= 3.88, 95%CI: 1.83-8.23, p <0.001), Intrauterine Growth Retardation(IUGR) (OR=6.73, 95%CI: 3.06-14.78, p <0.001), Neonatal Intensive Care Unit (NICU) admission (OR=3.49, 95%CI: 1.61-7.61, p 0.002), low APGAR score (OR=2.31, 95%CI: 1.09-4.92, p 0.029) and neonatal Death (OR=3.16, 95%CI: 1.083-9.22, p 0.035) were associated with pregnancies complicated with obstetric cholestasis.
Conclusion: The women with obstetric cholestasis were found to have adverse pregnancy outcome compared to pregnant women without obstetric cholestasis. However, perinatal outcome is good in actively managed women.
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