Intrahepatic cholestasis of pregnancy

Last reviewed: 7 Jan 2023
Last updated: 18 Oct 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • pruritus
  • excoriations without rash
More key diagnostic factors

Other diagnostic factors

  • mild jaundice
Other diagnostic factors

Risk factors

  • family history of ICP
  • previous history of ICP
  • history of hepatitis C infection
  • cholelithiasis
  • chronic hepatitis B infection
  • multi-fetal pregnancy
  • assisted reproduction
  • ethnicity
More risk factors

Diagnostic investigations

1st investigations to order

  • bile acids
  • liver function tests
More 1st investigations to order

Investigations to consider

  • coagulation profile
  • hepatitis C virology
  • liver and biliary tract ultrasound
  • full blood count
  • auto-antibody tests
More investigations to consider

Treatment algorithm

ACUTE

gestational pruritis (serum bile acid concentrations <10 micromol/L)

mild intrahepatic cholestasis of pregnancy (serum bile acid concentrations ≥10 [or non-fasting, ≥19] and <40 micromol/L)

moderate intrahepatic cholestasis of pregnancy (serum bile acid concentrations ≥40 and <100 micromol/L)

severe intrahepatic cholestasis of pregnancy (serum bile acid concentrations ≥100 micromol/L)

Contributors

Authors

Catherine Williamson, FRCP, FMedSci

Professor of Women’s Health

King’s College London

Honorary Consultant in Obstetric Medicine

Guy’s and St Thomas’ NHS Foundation Trust

London

UK

Disclosures

CW is an author of a number of references cited in this topic. She consults for Mirum Pharmaceuticals and GSK and has been reimbursed for her time given to advise on ileal bile acid inhibitors. She has been a member of two Medical Research Council Boards (Public Health and Systems Medicine Board and Public Health Strategy Board) and is on the Scientific Committee of the Society for Endocrinology. CW has grants from NIHR, Diabetes UK, Lauren Page Trust, and ICP Support.

Caroline Ovadia, BMBCh, MA, PhD, MRCOG

Clinical Senior Lecturer in Obstetrics

King’s College London

Honorary Consultant Obstetrician

Guy’s and St Thomas’ NHS Foundation Trust

London

UK

Disclosures

CO is an author of a number of references cited in this topic. She consults for Mirum Pharmaceuticals.

Acknowledgements

Professor Catherine Williamson and Dr Caroline Ovadia would like to gratefully acknowledge Dr Robert H. Debbs and Dr Derek Jurus, previous contributors to this topic.

Disclosures

RHD and DJ declare that they have no competing interests.

Peer reviewers

Frank Lammert, MD

Director

Department of Internal Medicine II

Professor Internal Medicine

Saarland University Hospital

Homburg

Germany

Disclosures

FL declares that he has no competing interests.

Ron Librizzi, DO, FACOOG

Director

Maternal Fetal Medicine

Virtua Health System

Associate Professor of Obstetrics and Gynecology

Thomas Jefferson University School of Medicine

Philadelphia

PA

Disclosures

RL declares that he has no competing interests.

Vincenzo Berghella, MD, FACOG

Director

Maternal Fetal Medicine

Professor

Obstetrics and Gynecology

Thomas Jefferson University School of Medicine

Philadelphia

PA

Disclosures

VB declares that he has no competing interests.

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