Doppler Evaluation of Foetal Pulmonary Artery in Intrahepatic Cholestasis of Pregnancy: A Prospective Study

Intrahepatic cholestasis of pregnancy (ICP) is the most prevalent liver disease specific to pregnancy, with higher incidence of adverse pregnancy outcomes. Keeping this in mind, this study has been framed to compare the changes in foetal pulmonary artery Doppler in pregnancies complicated with ICP with normal pregnancies.

This prospective study included total of 100 patients as per the inclusion and exclusion criteria. These patients were divided into two groups: the case group (ICP pregnancies) and control group (normal pregnancies). The Doppler parameters were analysed in terms of acceleration time/ejection time (AT/ET) ratio and the maternal and foetal outcome were evaluated.

Significant differences were found in Doppler parameters between the groups, with longer acceleration times (AT), shorter ejection times (ET), and higher PATET ratios in the ICP cases, which signify altered right ventricular outflow parameters, suggesting compromised pulmonary hemodynamics in newborns of ICP-affected pregnancies. These parameters were significantly influenced by the severity of ICP. The AT and ET, which are measures of cardiac function, show weak correlations with the liver function markers (all below 0.23), suggesting minimal direct relationships between these cardiac parameters and liver dysfunction in ICP patients.

The altered Doppler parameters reflect changes in foetal pulmonary vascular resistance and could be indicative of lung immaturity or altered hemodynamics secondary to the toxic effects of elevated maternal bile acid levels.