Background: Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disorder unique to pregnancy and is characterized by pruritus, elevated serum bile acid levels and deranged liver function tests. Although maternal morbidity is generally limited, ICP has important fetal and neonatal implications, including preterm birth, fetal compromise and neonatal intensive care admission.

Objective: The present study was conducted to assess the fetomaternal outcomes in cases of intrahepatic cholestasis of pregnancy and to evaluate the association between disease severity and pregnancy outcomes.

Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynaecology at National Institute of Medical Sciences and Research, Jaipur, over a period of 18 months. A total of 61 pregnant women in the third trimester presenting with pruritus and elevated serum bile acid levels were included. Detailed clinical history, examination and investigations including liver function tests and serum bile acids were performed. Patients were followed till delivery and maternal outcomes such as mode of delivery, gestational age at delivery and postpartum complications, along with fetal outcomes including birth weight, Apgar score and NICU admission were recorded. Statistical analysis was carried out using SPSS software with significance considered at p<0.05.

Results: The mean maternal age was 26.89±4.58 years, with 68.86% aged 21–30 years. Multigravida women constituted 78.7% of the cohort and 70.5% were from rural areas. The mean gestational age at presentation was 35.15±3.35 weeks, and 86.9% presented between 35 and 39 weeks. The mean serum bile acid concentration was 27.88±12.13 µmol/L; most participants had mild biochemical disease, with 40.9% having bile acids <20 µmol/L and 57.4% having concentrations of 20–40 µmol/L. Full-term vaginal delivery occurred in 62.3%, preterm vaginal delivery in 21.3% and caesarean delivery in 16.4%. Overall, 34.5% of pregnancies resulted in preterm birth. NICU admission was required for 16.4% of neonates. The mean Apgar score increased from 6.36±0.68 at 1 minute to 8.05±0.80 at 5 minutes. Higher bile acid categories were significantly associated with gestational outcome and Apgar scores, whereas the association with NICU admission was not statistically significant. ROC analysis showed an AUC of 0.962 for intrauterine death and 0.621 for NICU admission.

Conclusion: Intrahepatic cholestasis of pregnancy is associated with a higher incidence of preterm delivery and neonatal morbidity; however, with timely diagnosis, close monitoring and appropriate management, most pregnancies result in favorable maternal and neonatal outcomes. Early identification and regular antenatal surveillance are essential to reduce adverse fetomaternal complications