Colestasis intrahepática del embarazo

Abstract

Intrahepatic cholestasis is a disease characterized by pruritus and increase of the serum bile acids during the last trimester of pregnancy, associate with preterm delivery, fetal distress and high perinatal mortality. An update of this subject is presented based on our own experience and in the revision of the National and International literature. The cases occurred in the Obstetrics Division of the Cosme Argerich Hospital in three periods (1948-1969, 1975-1980 and 1992-1999) were analyzed. In 44,655 pregnancies 28 intrahepatic cholestasis were found (0.06%). The frequency increased during the different periods (from 0.01% to 0.16% in the last one). Pruritus was the most characteristic symptom and was present in all the patients. Jaundice appeared in few cases. Prematurity was complication (45.5%). Clinical manifestations, laboratory, differential diagnosis, perinatal outcome treatment and obstetrics management is described. We conclude that due to the low predictive value of the different methods we have to evaluate fetal surveillance in this disease, once we reach the complete somatic and pulmonary fetal maturation, according to neonatal admission level and obstetric conditions, interruption of pregnancy is considered.