Intrahepatic cholestasis of pregnancy

Abstract

Intrahepatic cholestasis of pregnancy (ICP) is a reversible cholestatic condition specific to pregnancy, characterized by pruritus, hepatic cytolysis and elevated serum bile acids. It usually starts at the end of the second or third trimester and is reversible rapidly after delivery. Incidence is higher in South American and Scandinavian countries (9.2-15.6% and 1.5% respectively) than in Europe (0.1-0.2%). Its aetiology is multifactorial, including genetic, endocrine and environmental factors. The maternal prognosis is usually benign, while fetal complications such as preterm birth, meconium apraxia, fetal distress and sudden intrauterine fetal death not infrequently lead to considerable perinatal morbidity and mortality. Ursodeoxycholic acid has proven to be the most effective therapeutic agent with proven safety and efficacy. Management of cholestasis of pregnancy (CP) consists of close monitoring of maternal liver function and serum bile acid levels, in addition to assessment of the fetal biophysical profile and delivery at the optimal time after fetal lung maturity. This article summarizes current information on CP based on recent literature data and presents an update on the diagnosis and management of this pathology.