May be associated with an increased risk of adverse pregnancy outcomes, including premature birth, intra-uterine fetal demise, and placental abruption in severe disease.
There is an increased risk of respiratory distress syndrome in neonates, owing to meconium aspiration syndrome, which is unpredictable by available methods of surveillance.
The only definitive cure is delivery of the baby.
The condition is associated with a history of hepatitis C and there may be an association with long-term liver disease.
Mild disease with bile acid levels <40 micromol/L or mild itching can be treated with bile-sequestering agents and antihistamines, such as colestyramine and hydroxyzine. However, if tolerated no treatment is necessary.
Severe disease with bile acid levels >40 micromol/L or severe pruritus remote from term can be treated effectively with ursodeoxycholic acid.
Close fetal surveillance with delivery near term can be expected with premature delivery reserved for those with severe, worsening disease despite treatment.
Intrahepatic cholestasis of pregnancy (ICP) is a pruritic condition during pregnancy caused by impaired bile flow allowing bile salts to be deposited in the skin and the placenta. The cause is a combination of hormonal, genetic, and environmental factors. ICP may predispose mothers to vitamin K deficiency and the fetus to adverse pregnancy outcomes that may include prematurity, intra-uterine fetal demise, and respiratory distress syndrome.
History and exam
Key diagnostic factors
- presence of risk factors
- pruritus, sparing the face
- excoriations without rash
Other diagnostic factors
- mild jaundice
- previous hx of intrahepatic cholestasis of pregnancy (ICP)
- hx hepatitis C
- FHx of intrahepatic cholestasis of pregnancy
- age >35 years
- multiple pregnancy
1st investigations to order
- bile acids
- coagulation profile
- fasting serum cholesterol
- hepatitis C virology
Investigations to consider
- liver biopsy
symptomatic mild disease (bile acids <40 micromol/L)
severe disease (bile acids ≥40 micromol/L) + gestational age <37 weeks
severe disease (bile acids ≥40 micromol/L) + gestational age ≥37 weeks
- Acute hepatitis
- HELLP syndrome
- Acute fatty liver of pregnancy
- Liver disease and pregnancy
- Obstetric cholestasis
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