Intrahepatic Cholestasis of Pregnancy
- Accounts for 20% of obstetric jaundice
- Presents with
- Generalized pruritus, +/- jaundice
- Absence of primary lesions
- Biochemical abnormalities consistent with cholestasis
- No history of exposure to hepatitis or hepatotoxic drugs
Pathophysiology
-
Thought to be due to increased levels of estrogen
-
Estrogen Effects
- Promotes cholestasis
- Inhibits reuptake of bile acids into hepatocytes
- Inhibits bile transport proteins
Findings
elevation of
- Raised bilirubin
- Raised transaminases
- Raised alkaline phosphatase
- the hallmark of ICP is elevation of serum bile acids.
ICP: Complications
A- For the mother, risks associated with ICP include 1- Bleeding 2- Intestinal malabsorption 3- Cholelithiasis
B- For the fetus risks include 1- Prematurity 2- Fetal distress 3- Death.
Treatment
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Although ICP resolves after delivery, treatment is indicated.
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The goal of treatment is to decrease circulating bile acids.
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Vitamin K supplementation plays a role in management if bleeding parameters become abnormal.
Therapeutic Options
The goal of treatment is to reduce symptoms and to prevent maternal and fetal complications.
-
early induction of labor, commonly at 37 to 38 weeks.
- When cholestasis is severe, delivery is considered earlier if fetal lung maturity is established.
-
Ursodeoxycholic acid
- Considered 1st- line treatment
Case Three: History
- Wala presents with intense, non-remitting pruritus without skin lesions.
- She is G3P2. Both previous pregnancies were uncomplicated. She is in her 30th week of gestation.
- She says the itch is worse after a hot shower.
- She is healthy, except for a history of eczema as a child and well-controlled hypothyroidism.