A STUDY TO DETERMINE THE PREVALENCE OF PRURITUS IN PREGNANT WOMEN AND ITS CORRELATION WITH OBSTETRICS CHOLESTASIS IN PREGNANCY AND ITS FETOMATERNAL OUTCOMES

Abstract

Background: Pruritus is a common symptom during pregnancy and may represent the earliest clinical manifestation of intrahepatic cholestasis of pregnancy (ICP), a pregnancy-specific liver disorder associated with significant maternal and fetal complications. Early diagnosis is essential for improving pregnancy outcomes. Methods: A hospital-based prospective observational study was conducted among 245 pregnant women presenting with pruritus at a tertiary care teaching hospital over 18 months. Detailed clinical evaluation, liver function tests, serum bile acid estimation, and obstetric assessment were performed. Participants were categorized into ICP and non-ICP groups based on clinical and biochemical findings and followed until delivery. Maternal and neonatal outcomes were compared using appropriate statistical tests, with a p-value of <0.05 considered statistically significant. Results: Among the 245 participants, 60 women (24.5%) were diagnosed with ICP. The majority developed pruritus between 28 and 32 weeks of gestation (31.8%). Women with ICP showed significantly greater involvement of the palms and soles, generalized pruritus, elevated liver enzymes, and abnormal serum bile acid levels. Maternal complications, including gestational diabetes mellitus (20.0%), preterm premature rupture of membranes (10.0%), preterm delivery (40.0%), and lower segment caesarean section (58.3%), were significantly more common among women with ICP. Neonatal outcomes such as meconium-stained liquor (43.3%), intrauterine growth restriction (16.7%), neonatal intensive care unit admission (35.0%), and Apgar score <7 at 5 minutes (13.3%) were also significantly higher in the ICP group. Conclusion: Nearly one-fourth of pregnant women presenting with pruritus had intrahepatic cholestasis of pregnancy. ICP was significantly associated with adverse maternal and neonatal outcomes. Early recognition of persistent pruritus, prompt biochemical evaluation, and timely obstetric management are essential to reduce fetomaternal morbidity and improve pregnancy outcomes.