Resumo
Definição
Анамнез и осмотр
Ключевые диагностические факторы
- presença de fatores de risco
- prurido
- escoriações sem erupção cutânea
Другие диагностические факторы
- icterícia leve
Факторы риска
- 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
Диагностические исследования
Исследования, которые показаны в первую очередь
- ácidos biliares
- testes da função hepática
Исследования, проведение которых нужно рассмотреть
- perfil de coagulação
- virologia para hepatite C
- ultrassonografia do trato hepático e biliar
- hemograma completo
- testes de autoanticorpos
Treatment algorithm
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)
Contributors
Authors
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
Disclosures
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
Disclosures
CO is an author of a number of references cited in this topic. She has consulted for Mirum Pharmaceuticals.
Acknowledgements
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.
Disclosures
RHD and DJ declare that they have 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.
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.
References
Key articles
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.Full text Abstract
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].Full text Abstract
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.Full text Abstract
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.Full text Abstract
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.Full text Abstract
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.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Hepatite viral aguda
- Síndrome HELLP (hemólise, enzimas hepáticas elevadas e plaquetopenia)
- Esteatose hepática aguda da gravidez
More DifferentialsGuidelines
- Pregnancy-related gastrointestinal and liver disease
- EASL Clinical practice guidelines on the management of liver diseases in pregnancy
More GuidelinesLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer