Frequency of Obstetric Intrahepatic Cholestasis and Its Maternal and Neonatal Outcomes: A Descriptive Cross-Sectional Study at Aga Khan University Hospital

Abstract

Objective: To determine the frequency of intrahepatic cholestasis of pregnancy and to describe maternal and neonatal outcomes among affected women in a tertiary care setting in Karachi.

Methodology: This descriptive cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Aga Khan University Hospital, Karachi, and included 162 pregnant women with biochemically confirmed intrahepatic cholestasis of pregnancy (total bile acids ≥19 µmol/L). Data on maternal and neonatal outcomes such as preterm birth, meconium-stained liquor, and NICU admission were collected using a structured proforma. Statistical analysis was performed using SPSS version 26.0, applying Chi-square with p ≤ 0.05 considered significant.

Results: Among the total 2569 deliveries during the study period, ICP was diagnosed in 162 women (6.31%). The mean maternal age among affected women was 30.09±4.58 years, and 59.9% were multigravida. Caesarean delivery occurred in 48.1%, gestational diabetes mellitus in 50.6%, and postpartum haemorrhage in 15.4%. Foetal outcomes included preterm birth (29.6%), low birth weight (17.9%), and NICU admission (13.6%). Small-for-gestational-age infants and intrapartum foetal distress each occurred in 11.1% of cases, whereas respiratory distress syndrome was observed in 9.3%.

Conclusion: Intrahepatic cholestasis of pregnancy demonstrated a considerable frequency of maternal and neonatal complications in this tertiary care setting. The most frequent maternal outcomes included gestational diabetes, caesarean delivery, and postpartum haemorrhage, while preterm birth, low birth weight, and NICU admission were the predominant neonatal outcomes. Early diagnosis, close biochemical monitoring, and timely obstetric intervention may help improve perinatal outcomes and reduce complications among affected Pakistani women.