Abstract :
Background: Intrahepatic cholestasis of pregnancy (ICP) is a unique pregnancy dermatosis and cholestatic disorder characterized by pruritus in 2nd and 3rd trimesters of pregnancy. It can be diagnosed using increased level of serum bile acids and by excluding other liver and skin disorders. ICP causes significant risks to both maternal and fetal health. The main aim of this study is to analyse the differing levels of maternal serum TBA that correlate with both maternal and fetal outcomes in obstetric cholestasis.Materials and Methods: A prospective observational and comparative study was carried out for over 12 months in the Department of Obstetrics & Gynaecology at Bokaro General Hospital, India. It involved 84 pregnant women with ICP. Participants were categorized into two groups based on serum TBA levels. Based on inclusion and exclusion criteria maternal and fetal outcomes were assessed through clinical history and examination, laboratory tests, and regular fetal monitoring using non-stress tests and obstetric ultrasound and Doppler studies. Statistical analysis was performed by SPSS version 24.Results: 84 patients in this study were divided into two groups equally based on bile acid levels, group A (< 40 p=0.001) p=0.03). p=0.001) p=0.03).>32weeks and one at near term. Fetal biometry measured (CRL-crown rump length, BPD-Biparietal diameter, HC-head circumference, AC-abdominal circumference, FL-femoral length, EFW-estimated fetal weight) were plotted on IG-21st charts and monitored the fetal growth. The neonatal parameters at birth and perinatal outcome were noted.Results: Ninety six (96%) fetuses had normal growth curves (NGC) for all assessed parameters. Four (4%) had growth curves (GC) for AC and EFW falling below NGC indicating fetal growth restriction (FGR).At birth, all these 4 babies (100%) had LBW indicating that fetal monitoring using IG-21st had accurately identified all (100%) fetuses at risk for FGR and AC and EFW were better parameters for assessment of FGR compared to HC, BPD and FL.), but were AGA (appropriate for gestational age); thus, indicating applicability of IG-21st.Conclusion: The IG-21st reference standards have a high predictive value for growth deviations and applicable to our population for antenatal fetal growth monitoring.
Keyword :
INTERGROWTH-21st Reference Standard Charts, Fetal growth monitoring, FGR, SGA, LBW, Perinatal outcome, Fetal biometry, NT scan, Anomaly scan, Growth scan.