Use of Rifampicin as a Recent Advancement in Treatment of Resistant and Severe Cases of Intrahepatic Cholestasis of Pregnancy for Better Fetal Outcome

Background: High levels of estrogen and progesterone during pregnancy are implicated in improper clearance of bile acids from liver leading to raised serum bile acids in Intrahepatic Cholestasis of pregnancy (ICP). Its main symptom is pruritus and poor fetal outcome is feared of it. Ursodeoxycholic acid (UDCA) leads to relief in this pruritus and lowering of serum bile acids, thereby reducing fetal complications such as preterm birth, stillbirth and meconium-stained liquor.

Methods: This chapter is based on a prospective study conducted at a tertiary care teaching hospital in Bihar, India. 108 women were included in this study, where all were begun on oral UDCA. Satisfactory relief in pruritus was reported by 78 subjects who were labelled as group A. Remaining 30 were given Rifampicin in addition to UDCA, and they were called Group B. Both groups were compared for fetal outcomes, mode and timing of birth.

Results: The demographic, obstetric and medical parameters were comparable for both the groups. The mean (Standard Deviation = SD) gestational age at delivery was 37.011 (1.18) weeks in group A and 35.70 (2.57) weeks in group B [p value = 0.012]. 63.0% (46) and 50% (15) babies in groups A and B respectively were born full-term and 37.0% (27) in group A and 50% (15) in group B were born preterm [p value = 0.222]. Spontaneous preterm delivery was seen in 17.8% of group A study subjects and 26.67% participants in Group B [p value = 0.310]. Rate of Neonatal Unit (NNU) admission was 35.9% and 50% respectively for neonates born to Group A and Group B participants [p value = 0.182]. There was no significant difference in the adverse fetal/neonatal outcome and still birth rates {9% versus 6.7% in groups A & B respectively} [p value = 0.722]. There was no significant difference between the two groups in terms of the distribution of the mode of delivery (X2 = 3.380, p = 0.337).

Conclusion: Addition of Rifampicin is sometimes needed in patients with earlier onset of ICP who do not respond satisfactorily to UDCA. Using this drug as an adjunct to UDCA does not lead to poor feto-maternal outcome.