Author(s)

Senani Hemantha Dodampahala^1*, Hemantha Pieris², Lal Gotabaya Chandrasena³, Surangi Jayakody⁴, Chamara Gunathilaka⁵, Chandrika Neelakanthi Wijayaratne¹, Gayani Sandamali Kotuwegedara Dodampahala⁶, Amila Ruwan Meegahawatta¹

¹University Gynaecology and Obstetrics Unit, De Zoysa Maternity Hospital, Colombo, Sri Lanka.
²University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
³Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka.
⁴Post Graduate (MD) Trainee in Community Medicine, Colombo, Sri Lanka.
⁵De Soyza Maternity Hospital, Colombo, Sri Lanka.
⁶National Hospital of Sri Lanka, Colombo, Sri Lanka.

Obstetric cholestasis (also referred to as intrahepatic cholestasis of pregnancy—ICP) is a pruritic form of reversible cholestasis that is associated with significant fetal risks. There is a paucity of research regarding pregnancy outcomes of the mothers with obstetric cholestasis in the South Asian setting. Hence, the objective of this study was to determine the prevalence of obstetric cholestasis among mothers presenting with pruritus during pregnancy and to describe the characteristics and outcomes for those diagnosed with ICP in comparison with those with pruritus in the absence of ICP. Methods: All mothers presenting with pruritus to De Soyza Maternity hospital in Colombo Sri Lanka, between 1st January 2011 to 1st January 2014, were recruited for the study. A standard set of biochemical tests were used for diagnosis of ICP. An interviewer administered questionnaire and patient records were used for data collection. Presentation, characteristics and pregnancy outcomes were assessed and compared for mothers with ICP against those with pruritus in the absence of ICP. Results: The prevalence of ICP in the study population was found to be 27% (n = 27). Generalized pruritus with pruritus of the palms and soles was identified as the commonest pattern of pruritus for diagnosed with ICP. Delivery before 37 weeks (p = 0.001), meconium stained liquor (p = 0.004), placental abruption (p = 0.005), postpartum hemorrhage (p = 0.005), bleeding manifestation (p = 0.006), preterm labor (p = 0.031) and fetal distress (p = 0.035) were found to be significantly associated with the presence of ICP. Conclusions: Nearly 1/3 of mothers presenting with pruritus in pregnancy in Sri Lanka are affected by ICP which is associated with an increase in a wide range of adverse maternal and fetal outcomes compared to those with pruritus in the absence of ICP.

Bile Acid, Intrahepatic Cholestasis, Liver Disease, Pregnancy Complications, Pruritus

Dodampahala, S. , Pieris, H. , Chandrasena, L. , Jayakody, S. , Gunathilaka, C. , Wijayaratne, C. , Dodampahala, G. and Meegahawatta, A. (2016) Presence of Obstetrics Cholestasis in Mothers Presenting with Pruritus in Pregnancy: In a Low Resource South Asian Setting. Advances in Reproductive Sciences, 4, 37-45. doi: 10.4236/arsci.2016.42006.