Evaluation of Doppler parameters and obstetric outcomes in intrahepatic cholestasis of pregnancy

Objectives To investigate the association between Doppler ultrasonographic parameters and maternal serum bile acid levels in pregnancies complicated by intrahepatic cholestasis of pregnancy (ICP) and to evaluate their potential role in fetal monitoring. Methods In this prospective observational study, 59 pregnant women diagnosed with ICP and 59 healthy controls were included. The diagnosis of ICP was based on pruritus and serum bile acid levels >10 μmol/L. Doppler assessments – performed by a blinded perinatologist – included the uterine artery pulsatility index (PI), middle cerebral artery (MCA) PI, umbilical artery (UA) PI, and cerebroplacental ratio (CPR). Participants were further stratified by bile acid levels (<10, 10–40, >40 μmol/L), and intergroup comparisons and correlation analyses were performed. Results The ICP cases had significantly higher uterine artery PI and lower MCA PI and CPR values compared to controls (p<0.05). Bile acid levels were positively correlated with uterine artery PI and inversely correlated with MCA PI and CPR. ICP pregnancies also demonstrated increased rates of preterm delivery, low birth weight, and neonatal intensive care unit (NICU) admissions. Conclusions Alterations in uterine and fetal Doppler indices in ICP pregnancies suggest underlying placental dysfunction. These findings support the clinical utility of Doppler ultrasound in the risk stratification and perinatal surveillance of patients with ICP.