Colestasis intrahepática del embarazo: implicaciones maternas y perinatales

OBJECTIVE: To evaluate the maternal and perinatal outcomes associated with intrahepatic cholestasis of pregnancy. MATERIALS AND METHODS: A retrospective cohort study carried out in pregnant patients diagnosed with intrahepatic cholestasis, who attended the Bolivarian University Clinic of Medellín, Colombia, between January 2000 and June 2016. Maternal variables evaluated: preeclampsia, diabetes gestational, hypertensive disorders of pregnancy, preterm birth, cholelithiasis, intrauterine growth restriction, postpartum hemorrhage, gestational age at birth, birth route. Perinatal outcomes: meconium in amniotic fluid, birth weight, Apgar score; Hyaline membrane disease, transient tachypnea of the newborn, intraventricular hemorrhage, admission to the neonatal intensive care unit and neonatal mortality. The association with maternal-perinatal outcomes was estimated using relative risk adjusted by covariates. RESULTS: 271 patients were included: 134 in the intrahepatic cholestasis group and 137 in the control group. Patients with intrahepatic cholestasis manifested pruritus and abnormal liver tests. Intrahepatic cholestasis showed statistical significance with advanced maternal age, multiple pregnancy, induction of labor and termination of pregnancy by caesarean section. Cholelithiasis (RRa 15.9 95% CI 2.19-115.86), preterm birth (RRa 2.57, 95% CI 1.37-4.83), meconium in amniotic fluid (RRa 3.04, 95% CI 1.14-8.08) and low birth weight (medium difference 300 g; 95% CI 190-400) were independent factors associated with intrahepatic cholestasis. No statistically significant relationship was found between intrahepatic cholestasis and maternal, fetal or neonatal mortality. CONCLUSIONS: Intrahepatic cholestasis is usually associated with maternal and perinatal adverse outcomes that induce labor at a gestational age at the lower limit of term pregnancy. The decision to end the pregnancy has a positive impact on neonatal morbidity and mortality.