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Colestase intra-hepática gestacional

Последний просмотренный: 5 Aug 2025
Last updated: 19 Mar 2025

Резюме

Определение

Анамнез и осмотр

Ключевые диагностические факторы

  • presença de fatores de risco
  • prurido
  • escoriações sem erupção cutânea
Полная информация

Другие диагностические факторы

  • icterícia leve
Полная информация

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
Полная информация

Диагностические исследования

Исследования, которые показаны в первую очередь

  • ácidos biliares
  • testes da função hepática
Полная информация

Исследования, проведение которых нужно рассмотреть

  • perfil de coagulação
  • virologia para hepatite C
  • ultrassonografia do trato hepático e biliar
  • hemograma completo
  • testes de autoanticorpos
Полная информация

Алгоритм лечения

Острый

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)

Составители

Авторы

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

Раскрытие информации

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

Раскрытие информации

CO is an author of a number of references cited in this topic. She has consulted for Mirum Pharmaceuticals.

Выражение благодарностей

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.

Раскрытие информации

RHD and DJ declare that they have no competing interests.

Рецензенты

Frank Lammert, MD

Director

Department of Internal Medicine II

Professor Internal Medicine

Saarland University Hospital

Homburg

Germany

Раскрытие информации

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

Раскрытие информации

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.

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.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

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 diferenciais
  • Diretrizes

    • Pregnancy-related gastrointestinal and liver disease
    • EASL Clinical practice guidelines on the management of liver diseases in pregnancy
    Mais Diretrizes
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