Intrahepatic cholestasis of pregnancy
From Ganfyd
Web Resources for Intrahepatic cholestasis of pregnancy
ICD 10 code: O26.6
Relevant Clinical Literature
UK Guidance
Wikis/Reviews
Wikipedia on Intrahepatic cholestasis of pregnancy (Less technical, ? quality control)
UpToDate® on Intrahepatic cholestasis of pregnancy (Technical, SUBSCRIPTION)
Intrahepatic cholestasis of pregnancy (obstetric cholestasis) is characterised by[1]:
- Pruritus
- Raised liver enzymes in blood
- Raised bile acids (Taurocholate) in blood
- Elevated disulphated progesterone metabolites
Contents |
Presentation
- Usually late second and third trimester
- Can be as early as 6 weeks gestation
- Less than 1% of pregnancies
- Some racial variation
- Association with estrogen receptor polymorphisms[2]
Pathophysiology
- Transplacental transfer of bile acids is impaired
- Lysophosphatidic acid may mediate the puritus through induction of autotaxin[3]
Differential diagnosis
Prognosis
- Usual benign (does not appear to influence perinatal mortality in modern obstetric practice)
- Increased risk of:
- Spontaneous preterm labour
- Meconium and asphyxial events
- Puritus resolves almost immediately after delivery. Liver function returns fully to normal within a
few weeks of delivery.
Treatment
- Ursodeoxycholic acid has a less than ideal evidence base but is widely used[4][1]
- Elective delivery around 37-38 weeks gestation (no good evidence base but is widely used)
This article is a work in progress. Please feel free to contribute to it.
References
- ↑ a b Glantz A, Reilly SJ, Benthin L, Lammert F, Mattsson LA, Marschall HU. Intrahepatic cholestasis of pregnancy: Amelioration of pruritus by UDCA is associated with decreased progesterone disulphates in urine. Hepatology (Baltimore, Md.). 2008 Feb; 47(2):544-51.(Link to article – subscription may be required.)
- ↑ Yin Y, Li F, Wang D. Association between estrogen receptor beta gene polymorphisms in Chinese Uygur patients and intrahepatic cholestasis of pregnancy.. Zhonghua yi xue yi chuan xue za zhi = Zhonghua yixue yichuanxue zazhi = Chinese journal of medical genetics. 2012 Jun; 29(3):319-22.(Link to article – subscription may be required.)
- ↑ Oude Elferink RP, Kremer AE, Martens JJ, Beuers UH. The molecular mechanism of cholestatic pruritus. Digestive diseases (Basel, Switzerland). 2011; 29(1):66-71.(Link to article – subscription may be required.)
- ↑ Glantz A, Marschall HU, Lammert F, Mattsson LA. Intrahepatic cholestasis of pregnancy: a randomized controlled trial comparing dexamethasone and ursodeoxycholic acid. Hepatology (Baltimore, Md.). 2005 Dec; 42(6):1399-405.(Link to article – subscription may be required.)
