Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- pruritus, sparing the face
- excoriations without rash
Other diagnostic factors
- mild jaundice
Risk factors
- previous hx of intrahepatic cholestasis of pregnancy (ICP)
- hx hepatitis C
- FHx of intrahepatic cholestasis of pregnancy
- age >35 years
- multiple pregnancy
Diagnostic investigations
1st investigations to order
- bile acids
- LFTs
- coagulation profile
- fasting serum cholesterol
- hepatitis C virology
Investigations to consider
- liver biopsy
Treatment algorithm
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
Contributors
Authors
Robert H. Debbs, DO, FACOOG
Associate Professor of Obstetrics and Gynecology
Division of Maternal Fetal Medicine
University of Pennsylvania School of Medicine
Director
Pennsylvania Hospital Maternal Fetal Medicine Network
Philadelphia
PA
Disclosures
RHD declares that he has no competing interests.
Acknowledgements
Dr Robert H. Debbs would like to gratefully acknowledge Dr Derek Jurus, a previous contributor to this monograph. DJ declares that he has 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.
Differentials
- Acute hepatitis
- HELLP syndrome
- Acute fatty liver of pregnancy
More DifferentialsGuidelines
- Liver disease and pregnancy
- Obstetric cholestasis
More GuidelinesPatient leaflets
Hepatitis C: what is it?
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