Intrahepatic Cholestasis of Pregnancy
Not yet clinically reviewed
This protocol was migrated from the earlier Pharmapedia and Ward Guide apps for educational use. Follow your hospital's own policies and consult seniors when in doubt.
Introduction
- Intrahepatic cholestasis of pregnancy is characterized by incomplete clearance of bile acids in genetically susceptible women.
- The principal symptom is pruritus, which can be generalized but tends to have a predilection for the palms and soles.
- Presentation is typically in the third trimester, and women with multi - fetal pregnancies are at increased risk.
- The finding of an elevated serum bile acid level, ideally performed in the fasting state, confirms the diagnosis.
- Associated laboratory derangements include modest elevations in hepatic transaminase levels and mild hyperbilirubinemia.
- The symptoms and laboratory abnormalities resolve quickly after delivery but can recur in subsequent pregnancies or with exposure to combination oral contraceptives.
Treatment
- Tab- Urso (Ursodeoxycholic acid) 500mg (8-10 mg / kg / day), 1 tablet PO X OD.
- Supportive care for other complaints
Complications
- Adverse fetal outcomes, particularly preterm birth, nonreassuring fetal status, meconium-stained amniotic fluid, and still birth, have consistently been reported in women with cholestasis of pregnancy.
- The risk for adverse perinatal outcomes appears to correlate with disease severity as measured by the degree of bile acid elevation, and women with fasting bile acids greater than 40 mcmol/L have been reported to be at greatest risk.