Clinical Profile and Perinatal Outcomes in Intrahepatic Cholestasis of Pregnancy: An observational study from Tripura, India

Abstract

Background

Intrahepatic cholestasis of pregnancy (IHCP) is a liver disorder in pregnancy linked to maternal

discomfort and adverse perinatal outcomes.Despite existing studies, data from Tripura remain

unavailable. This study evaluated the clinical profile and perinatal outcomes of IHCP in this region.

Methods

A prospective observational study was conducted from July 2022 to June 2023 at Tripura Medical

College & Dr. BRAM Teaching Hospital. Eighty singleton pregnant women beyond 28 weeks

gestation diagnosed with IHCP based on clinical features, elevated liver enzymes, and serum bile acid

levels were enrolled. Patients received ursodeoxycholic acid (UDCA) therapy and were monitored

until delivery and 14 days postpartum. Maternal and neonatal outcomes, including delivery mode,

fetal distress, birth weight, APGAR scores, neonatal intensive care unit admissions, and early

neonatal deaths, were recorded and analyzed.

Results

The mean maternal age was 27.4 ± 4.9 years, with 61.2% primigravida. The mean serum bile acid level

at diagnosis was 38.6 ± 17.3 µmol/L, indicating predominantly mild IHCP. Labor was induced in 70%

of cases, and caesarean section was performed in 58.8%. Intrapartum fetal distress occurred in 30%

of pregnancies. The mean gestational age at delivery was 37.5±1.6 weeks. Neonatal outcomes

showed a mean birth weight of 2.8±0.4 kg, with 13.7% low birth weight. Resuscitation was required

in 32.5% of neonates, and 32.5% required SNCU admission. Early neonatal death occurred in 6.3% of

cases. Neonatal complications included birth asphyxia, meconium aspiration syndrome, respiratory

distress syndrome, and neonatal jaundice.

Conclusion

IHCP in Tripura presents with clinical and biochemical profiles consistent with existing literature.

Perinatal morbidity and mortality remain significant, underscoring the importance of close fetal

monitoring and individualized delivery planning based on serum bile acid levels. Further large-scale

studies are needed to optimize management and outcomes in this population.