Cholestasis of pregnancy

Last reviewed: 25 Apr 2022
Last updated: 10 Oct 2017

Summary

Definition

History and exam

Key diagnostic factors

  • pruritus, sparing the face
  • excoriations without rash
More key diagnostic factors

Other diagnostic factors

  • mild jaundice
Other diagnostic factors

Risk factors

  • previous hx of intrahepatic cholestasis of pregnancy
  • hx hepatitis C
  • FHx of intrahepatic cholestasis of pregnancy
  • age >35 years
  • multiple pregnancy
More risk factors

Diagnostic investigations

1st investigations to order

  • bile acids
  • LFTs
  • coagulation profile
  • fasting serum cholesterol
  • hepatitis C virology
More 1st investigations to order

Investigations to consider

  • liver biopsy
More investigations to consider

Treatment algorithm

ACUTE

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

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    • HELLP syndrome
    • Acute fatty liver of pregnancy
    More Differentials
  • Guidelines

    • Liver disease and pregnancy
    • Obstetric cholestasis
    More Guidelines
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    Hepatitis C: what is it?

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