Diagnostic Significance of Serum Total Bile Acid Levels in Suspected Cases of Obstetric Cholestasis

Abstract

Introduction: Intrahepatic Cholestasis of Pregnancy (ICP) is significantly associated with adverse maternal and fetal outcome and therefore accurate diagnosis and timely initiation of therapy is of utmost importance. Aims & Objectives: To find out the diagnostic significance of serum total bile acid measurement in suspected cases of obstetric cholestasis. Place and duration of study: It was a cross sectional study conducted in the Department of Clinical Chemistry and Immunology, Chughtai Institute of Pathology from July 2018 to February 2019. Material & Methods: Two hundred pregnant females whose serum total bile acid (TBA) was determined were included in the study. Pregnant females with cholestasis due to medical reasons other than ICP were excluded from the study. The patients were contacted for relevant clinical details which were recorded on a pre-designed proforma. Data was analyzed using SPSS 23.0. Univariate analysis was done to find out percentages and frequencies. Results: Mean age of 200 pregnant females was 27 years having Mean TBA value of 32.8 μmol/L. 63% females were primiparous. 197 (98.5%) patients gave the history of pruritus while 193 (96.5%) patients presented with dark urine. Only 30 patients (15%) gave history of using progesterone during pregnancy. Total Bile acid value was >10 μmol/L for 84 primiparous and 48 multiparous cases (n=132). There was no significant difference in the mean TBA value on the basis of parity, medication, mode of delivery or presence and absence of itch. Conclusion: ICP is a multi factorial reversible condition and bile acid estimation plays a major role in correct clinical assessment of patients with obstetric cholestasis.