Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- pruritus
- excoriations without rash
Outros fatores diagnósticos
- mild jaundice
Fatores de risco
- family history of ICP
- previous history of ICP
- history of hepatitis C infection
- cholelithiasis
- chronic hepatitis B infection
- multifetal pregnancy
- assisted reproduction
- ethnicity
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- bile acids
- liver function tests
Investigações a serem consideradas
- coagulation profile
- hepatitis C virology
- liver and biliary tract ultrasound
- complete blood count
- autoantibody tests
Algoritmo de tratamento
gestational pruritus (serum bile acid concentrations <10 micromol/L)
mild intrahepatic cholestasis of pregnancy (serum bile acid concentrations ≥10 [or nonfasting, ≥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)
Colaboradores
Autores
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
Declarações
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
Declarações
CO is an author of a number of references cited in this topic. She has consulted for Mirum Pharmaceuticals.
Agradecimentos
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.
Declarações
RHD and DJ declare that they have no competing interests.
Revisores
Frank Lammert, MD
Director
Department of Internal Medicine II
Professor Internal Medicine
Saarland University Hospital
Homburg
Germany
Declarações
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
利益声明
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
利益声明
VB declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Ovadia C, Seed PT, Sklavounos A, et al. Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results of aggregate and individual patient data meta-analyses. Lancet. 2019 Mar 2;393(10174):899-909.全文 摘要
Girling J, Knight CL, Chappell L, et al. Intrahepatic cholestasis of pregnancy: green-top guideline no. 43 June 2022. BJOG. 2022 Aug 9 [Epub ahead of print].全文 摘要
Glantz A, Marschall HU, Mattsson LA. Intrahepatic cholestasis of pregnancy: relationships between bile acid levels and fetal complication rates. Hepatology. 2004 Aug;40(2):467-74.全文 摘要
Society for Maternal-Fetal Medicine; Lee RH, Greenberg M, Metz TD, et al. Society for Maternal-Fetal Medicine consult series #53: Intrahepatic cholestasis of pregnancy: replaces consult #13, April 2011. Am J Obstet Gynecol. 2021 Feb;224(2):B2-9.全文 摘要
European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu, European Association for the Study of the Liver. EASL clinical practice guidelines on the management of liver diseases in pregnancy. J Hepatol. 2023 Sep;79(3):768-828.全文 摘要
Walker KF, Chappell LC, Hague WM, et al. Pharmacological interventions for treating intrahepatic cholestasis of pregnancy. Cochrane Database Syst Rev. 2020 Jul 27;7(7):CD000493.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Acute viral hepatitis
- HELLP syndrome
- Acute fatty liver of pregnancy
更多 鉴别诊断指南
- Pregnancy-related gastrointestinal and liver disease
- Intrahepatic cholestasis of pregnancy – diagnosis and management: a consensus statement of the Society of Obstetric Medicine of Australia and New Zealand (SOMANZ)
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