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Chapter 40 - Intrahepatic Cholestasis of Pregnancy

from Section 7 - Hepato-Renal and Gastrointestinal Conditions in Pregnancy

Published online by Cambridge University Press:  23 February 2023

By
Amanda Malik ,
Meena Khandelwal  and
Amira El-Messidi
Edited by
Amira El-Messidi  and
Alan D. Cameron
Amira El-Messidi
Affiliation:
McGill University, Montréal
Alan D. Cameron
Affiliation:
University of Glasgow
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Summary

During your overnight call duty, a 37-year-old G2P1 with a spontaneous pregnancy presents to the obstetrics emergency assessment unit of your tertiary center at 32+3 weeks’ gestation with pruritis preventing her from sleep. She has no obstetric complaints; cardiotocography initiated upon the patient’s presentation shows a normal fetal heart tracing and uterine quiescence.

Keywords

Prenatal pruritis, differential diagnosisIntrahepatic cholestasis of pregnancy, obstetric cholestasisDiagnosisRisk factorsInvestigationsPerinatal risks, complications, maternal-fetal morbidity, fetal mortality, pathophysiologyPharmacologic treatmentAntepartum managementObstetric deliveryContraceptionPreconception counseling
Type
Chapter
Information
OSCEs in Obstetrics and Maternal-Fetal Medicine
An Evidence-Based Approach
 , pp. 521 - 530
Publisher: Cambridge University Press
Print publication year: 2023

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References

Suggested Readings

ACOG Committee Opinion No. 764: Medically indicated late-preterm and early-term deliveries. Obstet Gynecol. 2019 Feb;133(2):e151–e155.CrossRefGoogle Scholar
Bicocca, MJ, Sperling, JD, Chauhan, SP. Intrahepatic cholestasis of pregnancy: Review of six national and regional guidelines. Eur J Obstet Gynecol Reprod Biol. 2018 Dec; 231:180–187.CrossRefGoogle ScholarPubMed
Chappell, LC, Bell, JL, Smith, A, et al. Ursodeoxycholic acid versus placebo in women with intrahepatic cholestasis of pregnancy (PITCHES): a randomised controlled trial. Lancet. 2019 Sep 7;394(10201):849–860.CrossRefGoogle ScholarPubMed
Geenes, V, Chappell, LC, Seed, PT, et al. Association of severe intrahepatic cholestasis of pregnancy with adverse pregnancy outcomes: a prospective population-based case-control study. Hepatology. 2014 Apr;59(4):1482–1491.CrossRefGoogle ScholarPubMed
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. [Erratum in Lancet. 2019 Mar 16;393(10176):1100]Google Scholar
Royal College of Obstetricians and Gynaecologists. Obstetric cholestasis: Green-Top Guideline No. 43. London: Royal College of Obstetricians and Gynaecologists; 2011.Google Scholar
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.Google ScholarPubMed
Society for Maternal-Fetal Medicine (SMFM). Lee, RH, Greenberg, M, Metz, TD, et al. Society for Maternal-Fetal Medicine Consult Series No. 53: Intrahepatic cholestasis of pregnancy: Replaces Consult No. 13, April 2011. Am J Obstet Gynecol. 2021;224(2):B2–B9.CrossRefGoogle Scholar
Tran, TT, Ahn, J, Reau, NS. American College of Gastroenterology (ACG) clinical guideline: liver disease and pregnancy. Am J Gastroenterol. 2016; 111(2):176–194.CrossRefGoogle Scholar
Williamson, C, Geenes, V. Intrahepatic cholestasis of pregnancy. Obstet Gynecol. 2014 Jul;124(1):120–133.CrossRefGoogle ScholarPubMed

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