Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- presença de fatores de risco
- prurido
- escoriações sem erupção cutânea
Outros fatores diagnósticos
- icterícia leve
Fatores de risco
- história familiar da CIG
- história pregressa de CIG
- história de infecção por hepatite C
- colelitíase
- infecção crônica por hepatite B
- gestação multifetal
- reprodução assistida
- etnia
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- ácidos biliares
- testes da função hepática
Investigações a serem consideradas
- perfil de coagulação
- virologia para hepatite C
- ultrassonografia do trato hepático e biliar
- hemograma completo
- testes de autoanticorpos
Algoritmo de tratamento
prurido gestacional (concentrações séricas de ácido biliar <10 micromoles/L)
coléstase intra-hepática gestacional leve (concentrações séricas de ácido biliar ≥10 [ou sem jejum, ≥19] e <40 micromoles/L)
coléstase intra-hepática gestacional moderada (concentrações séricas de ácido biliar ≥40 e <100 micromoles/L)
coléstase intra-hepática gestacional grave (concentrações séricas de ácido biliar ≥100 micromoles/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
Declarações
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
Declarações
VB declares that he has no competing interests.
Referências
Principais artigos
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.Texto completo Resumo
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].Texto completo Resumo
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.Texto completo Resumo
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.Texto completo Resumo
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.Texto completo Resumo
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.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Hepatite viral aguda
- Síndrome HELLP (hemólise, enzimas hepáticas elevadas e plaquetopenia)
- Esteatose hepática aguda da gravidez
Mais Diagnósticos diferenciaisDiretrizes
- Pregnancy-related gastrointestinal and liver disease
- EASL Clinical practice guidelines on the management of liver diseases in pregnancy
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