Intrahepatic cholestasis of pregnancy

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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

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)

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References

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