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Intrahepatic Cholestasis of Pregnancy
Aka: Intrahepatic Cholestasis of Pregnancy
- See Also
- Pruritus in Pregnancy
- Epidemiology
- Most common liver disease in pregnancy
- Incidence: 1-1.5% of pregnancies
- Pathophysiology
- Related to increased serum Estrogen levels
- Risk Factors
- Third Trimester pregnancy
- Multiple Gestation pregnancy
- Symptoms
- Severe Pruritus in third trimester of pregnancy
- Pruritus localized to trunk and extremities, especially palms and soles, and especially at night
- Abdominal Pain and Jaundice are uncommon
- Signs
- No rash
- No Jaundice in mild form (Prurigo gravidarum)
- Differential Diagnosis
- See Acute Hepatitis
- Hyperemesis Gravidarum
- Liver transaminases (AST, ALT) may be over 200 IU/L
- Alkaline Phosphatase may be increased up to twice normal
- Serum Bilirubin may be increased enough to cause visible Jaundice
- HELLP Syndrome
- Often associated with Preeclampsia with Severe Hypertension and Proteinuria
- Most commonly occurs in third trimester and immediately postpartum
- Acute Fatty Liver of Pregnancy
- Associated with more severe liver failure and Renal Insufficiency
- May be difficult to distinguish with HELLP Syndrome
- Labs
- Serum Bilirubin >4 mg/dl (>16 confers adverse fetal outcome)
- Serum transaminase (AST, ALT) levels may be >1000 IU/L
- Management
- Exclude other causes of liver disease (see differential diagnosis as above)
- Ursodeoxycholic Acid (Ursodiol)
- Reduces symptoms, reduces Serum Bilirubin levels, and prolongs gestation
- Brouwers (2015) Am J Obstet Gynecol 212(1): 100.e1 [PubMed]
- Other symptomatic management
- Oral Antihistamines for Pruritus
- Cholestyramine (Questran)
- Consult maternal fetal medicine
- Increased antepartum observation
- Plan delivery by 35-37 weeks gestation
- Course
- Resolves with delivery
- Complications
- Bilirubin is toxic to fetal cardiac cells, and causes Vasoconstriction of chorionic veins
- Adverse effects
- Preterm delivery
- Meconium-stained amniotic fluid
- Intrauterine Fetal Demise
- References
- Swencki (2015) Crit Dec Emerg Med 29(11):2-10