FETOMATERNAL OUTCOMES IN PATIENTS WITH OBSTETRIC CHOLESTASIS AT NORTHWEST GENERAL HOSPITAL PESHAWAR

Abstract

Background:
Obstetric cholestasis (OC), also known as intrahepatic cholestasis of pregnancy (ICP), is a cholestatic disorder unique to pregnancy associated with pruritus, elevated liver enzymes, and increased maternal and fetal complications. Data from Pakistan are limited, particularly from Khyber Pakhtunkhwa.

Objective:
To determine the fetomaternal outcomes of obstetric cholestasis in pregnant women attending Northwest General Hospital and Research Centre, Peshawar.

Methodology:
This descriptive study was conducted in the Department of Obstetrics and Gynecology, Northwest General Hospital and Research Centre, over six months. A total of 130 pregnant women diagnosed with OC were enrolled through non-probability consecutive sampling. Diagnosis was based on pruritus with elevated aminotransferases (>30 IU/L) and exclusion of other liver diseases. Demographic, clinical, and laboratory parameters were recorded in a predesigned proforma. Maternal and perinatal outcomes were noted, including mode of delivery, preterm delivery, preterm premature rupture of membranes (PPROM), postpartum hemorrhage (PPH), meconium-stained amniotic fluid, intrauterine growth restriction (IUGR), APGAR scores, and NICU admission. Data were analyzed using SPSS v25, with chi-square and Fisher’s exact test applied; p ≤ 0.05 was considered significant.

Results:
The mean age of patients was 29.4 ± 5.6 years, with most (68.5%) aged 18–30 years. The majority were multiparous (71.5%), urban residents (62.3%), and from middle socioeconomic backgrounds (57.7%). Elevated liver enzymes were observed in all cases. The most frequent maternal complications were preterm delivery (24.6%), PPROM (18.5%), postpartum hemorrhage (12.3%), and emergency cesarean section (21.5%). Perinatal complications included meconium-stained amniotic fluid (30.8%), abnormal cardiotocography (16.9%), low APGAR score at 5 minutes (14.6%), IUGR (10.0%), and NICU admissions (20.8%). Complications were more frequent among women aged 31–40 years, those with BMI >25 kg/m², and in cases where UDCA was not administered (p < 0.05).

Conclusion:
Obstetric cholestasis is associated with significant maternal and perinatal morbidity, including preterm delivery, cesarean section, PPH, meconium-stained amniotic fluid, and NICU admission. Early diagnosis and treatment with UDCA can reduce adverse outcomes. Given its frequency in our setting, routine screening of pregnant women presenting with pruritus in the third trimester is recommended