Increased point shear wave elastography values of the placenta, fetal lung, and fetal liver in patients with intrahepatic cholestasis of pregnancy

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OBJECTIVE: The application of point shear wave elastography (pSWE) in obstetrics gained popularity in examining the elasticity of the placenta and maternal tissues in high-risk pregnancies This study aimed to utilize pSWE to determine the elasticity values of these tissues in pregnant women with or without intrahepatic cholestasis of pregnancy (ICP), and to investigate its potential as a novel, non-invasive diagnostic approach beyond conventional methods. MATERIALS AND METHODS: This prospective case-control study, conducted between February 2022 and June 2023, included 120 singleton pregnant women (60 with ICP and 60 body mass index [BMI]- and gestational age-matched healthy controls). All participants underwent B-mode ultrasonography, Doppler examination, and pSWE at 36 weeks of gestation in a single session. Placental (central and peripheral), fetal lung, and fetal liver stiffness values were measured, and the mean of ten valid measurements was used for analysis. Correlations between stiffness values and biochemical parameters were evaluated. Logistic regression analyses were performed to identify independent predictors of ICP. RESULTS: Cases with ICP had a significantly higher mean stiffness value in both the peripheral (9.29 ± 2.45 kPa) and the central (9.03 ± 2.79 kPa) part of the placentas, fetal lung (10.86 ± 3.33 kPa), and fetal liver (4.85 ± 1.17 kPa) than those of the control cases (4.92 ± 2.26 kPa, 4.61 ± 2.11 kPa, 5.76 ± 2.62 kPa, and 3.81 ± 0.99 kPa, respectively, p < 0.001). There was a significant positive correlation between the mean elasticity values of the placenta, fetal lung, and fetal liver and AST, ALT, and TBA values at diagnosis, and a significant negative correlation between the mean elasticity values of the placenta, fetal lung, and fetal liver and the gestational week at diagnosis. CONCLUSION: We showed increased stiffness values on pSWE at the peripheral and central parts of the placenta, fetal lung, and fetal liver in ICP cases compared to healthy pregnancies. Also, higher stiffness values of the placenta and fetal organs were significantly and positively associated with AST, ALT, and TBA values at diagnosis, and significantly and negatively associated with the gestational week at diagnosis. The pSWE might provide evidence of histopathological findings in ICP.

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