International Journal of Clinical Obstetrics and Gynaecology

Background: Intrahepatic cholestasis of pregnancy (ICP) is characterized by pruritus of the hand and sole with abnormal liver function test and increased bile acid levels and presents during second and third trimesters of pregnancy and usually resolves after delivery. The present study was done to find out relationship between maternal outcomes in intrahepatic cholestasis of pregnancy (ICP) and serum bile acid levels.
Methods: A prospective observational study was conducted among Women beyond 28 weeks of gestation visiting ANC OPD or delivering in the maternity ward at St Stephen’s Hospital, Delhi, India over a period of two years February 2023 to February 2025. The study included 125 pregnant women with the complaint of pruritis in the palm and sole after 28 weeks of pregnancy and diagnosed with intrahepatic cholestasis of pregnancy after investigations.
Results: Maternal and fetal outcome data included parameters gestational age at delivery, incidence of preterm birth, mode of delivery, postpartum hemorrhage, low birth weight, NICU admissions, IUD and maternal morbidity. Serum bile acid concentrations were measured and correlated with recorded maternal and fetal outcomes. A positive correlation between higher bile acid levels and unfavorable maternal outcomes, with significant associations noted for increased rates of induced labor, higher mean hospital stay, low birth weight and lower APGAR score at 1 and 5 minutes. No statistically significant difference was found in preterm birth, meconium-stained liquor and NICU admissions among the two groups.
Conclusion: Severe ICP is associated with adverse pregnancy outcome especially low birth weight, lower APGAR scores, fetal distress and neonatal mortality with severe ICP. Thus serum bile acid quantification may serve as a valuable biomarker for risk stratification and management planning in ICP cases, emphasizing the importance of early detection and targeted monitoring for improved pregnancy care.