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

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.