Intrahepatic cholestasis of pregnancy- case series done in a tertiary care hospital

Aditi Kaundinya; Anuya Pawde; G. Sudharani; Sriram Gopal; Mayuri More

doi:10.18203/2320-1770.ijrcog20232966

Authors

Aditi Kaundinya Department of Obstetrics and Gynaecology, DY Patil School of Medicine, Navi Mumbai, Maharashtra, India
Anuya Pawde Department of Obstetrics and Gynaecology, DY Patil School of Medicine, Navi Mumbai, Maharashtra, India
G. Sudharani Department of Obstetrics and Gynaecology, DY Patil School of Medicine, Navi Mumbai, Maharashtra, India
Sriram Gopal Department of Obstetrics and Gynaecology, DY Patil School of Medicine, Navi Mumbai, Maharashtra, India
Mayuri More Department of Obstetrics and Gynaecology, DY Patil School of Medicine, Navi Mumbai, Maharashtra, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20232966

Keywords:

Cholestasis, Pregnancy, Pruritis, Bile acids, Ursodeoxycholic acid

Abstract

Intrahepatic cholestasis of pregnancy (ICP) also known as obstetric cholestasis is a liver disorder of pregnancy which is characterised by maternal pruritus usually in the third trimester, raised serum bile acids and increased incidence of adverse fetal outcomes and usually complete resolution of symptoms post-delivery. The etiology of ICP is complex and multifactorial as is the mechanism by which fetal complications occur which is yet not completely understood. The introduction of ursodeoxycholic acid in the management of ICP has provided significant improvement in maternal symptoms as well as fetal outcome. We present a case series of 5 cases of obstetric cholestasis which presented in our tertiary care hospital which could possibly help and guide obstetricians in the future who are dealing with dilemma in diagnosis and management of this condition.

Metrics

Metrics Loading ...

References

Westbrook RH, Dusheik OG, Williamson C. Pregnancy and liver disease. J Hepatol. 2016;64:933-45.

Clinical Updates in Women's Health Care Summary: Liver Disease: Reproductive Considerations. Obstet Gynecol. 2017;129(1):236.

Willaimson C, Geenes V. Intrahepatic cholestasis of pregnancy. Obstet Gynecol. 2014;124(1):120-33.

Ahlfeld F. Berichte und Arbeiten aus der Geburtshilflich-Gynaekologischen Klinik zu Giessen.Bokus; Leipzig, Germany. 1883.

Lammert F, Marschall HU, Glantz A, Matern S. Intrahepatic cholestasis of pregnancy: molecular pathogenesis, diagnosis and management. J Hepatol. 2000;33:1012-21.

Lee RH, Goodwin TM, Greenspoon J. The prevalence of intrahepatic cholestasis of pregnancy in a primarily Latina Los Angeles population. J Perinatol. 2006;26:527-32.

Reyes H, Gonzalez MC, Ribalta J. Prevalence of intrahepatic cholestasis of pregnancy in Chile. Ann Intern Med. 1978;88:487-93.

Reyes H, Ribalta J, Gonzalez M. Idiopathic cholestasis of pregnancy in a large kindred. Gut. 1976;17(9):709-13.

Reyes H, Simon FR. Intrahepatic cholestasis of pregnancy: an estrogen-related disease. Semin Liver Dis. 1993;13(3):289-301.

Palmer DG, Eads J. Intrahepatic cholestasis of pregnancy: a critical review. J Perinat Neonatal Nurs. 2000;14(1):39-51.

Bacq Y, Myara A, Brechot MC. Serum conjugated bile acid profile during intrahepatic cholestasis of pregnancy. J Hepatol. 1995;22:66-70.

Benifla JL, Dumont M, Levardon M. Effects of micronized natural progesterone on the liver during the third trimester of pregnancy. Contracept Fertil Sex. 1997;25(2):165-9.

Meng LJ, Reyes H, Palma J. Progesterone metabolites and bile acids in urine and serum of women with intrahepatic cholestasis of pregnancy. J Hepatol. 1997;27(2):346-57.

Reyes H, Baez ME, Gonsalez MC. Selenium, zinc and copper plasma levels in intrahepatic cholestasis of pregnancy in normal pregnancies and in healthy individuals in Chile. J Hepatol. 2000;32:542-9.

Bacq Y, Sapey T, Brechot MC. Intrahepatic cholestasis of pregnancy: a French prospective study. Hepatology. 1997;26(2):358-64.

Fagan EA. Intrahepatic cholestasis of pregnancy. Clin Liver Dis. 1999;3(3):603-32.

Brites D, Rodrigues CM, Cardoso MC. Unusual case of severe cholestasis of pregnancy with early onset, improved by ursodeoxycholic acid administration. Eur J Obstet Gynecol Reprod Biol. 1998;76:165-8.

Knox TA, Olans LB. Liver disease in pregnancy. N Engl J Med. 1996;335(8):569-76.

Nichols AA. Cholestasis of pregnancy: a review of the evidence. J Perinat Neonatal Nurs. 2005;19(3):217-25.

Mullaly BA, Hansen WF. Intrahepatic cholestasis of pregnancy: review of the literature. Obstet Gynecol Surv. 2002;57(1):47-52.

Walker IA, Nelson-Piercy C, Williamson C. Role of bile acid measurement in pregnancy. Ann Clin Biochem. 2002;39(2):105-13.

Brites D, Rodrigues CM, Van Zeller H. Relevance of serum bile acid profile in the diagnosis of intrahepatic cholestasis of pregnancy in an high incidence area: Portugal. Eur J Obstet Gynecol Reprod Biol. 1998;80(1):31-8.

Wόjcicka-Jagodzińska J, Kuczyńska-Sicińska J. Carbohydrate metabolism in the course of intrahepatic cholestasis in pregnancy. Am J Obstet Gynecol. 1989;161(4):959-64.

Jiang ZH, Qui ZD, Liu WW. Intrahepatic cholestasis of pregnancy and its complications. Analysis of 100 cases in Chingqing area. Chin Med J (Engl). 1986;99(12):957-60.

Bacq Y. Intrahepatic cholestasis of pregnancy. In UpToDate. Edited by: Rose and BD. Waltham, MA. 2006.

Fisk NM, Storey GN. Fetal outcome in obstetric cholestasis. Br J Obstet Gynaecol. 1988;95(11):1137-43.

Glantz A, Marschall HU, Mattsson LA. Intrahepatic cholestasis of pregnancy: Relationships between bile acid levels and fetal complication rates. Hepatology. 2004;40(2):467-74.

Germain AM, Carvajal JA, Glasinovic JC. Intrahepatic cholestasis of pregnancy: an intriguing pregnancy specific disorder. J Soc Gynecol Investig. 2002;9(1):10-4.

Kondrackiene J, Beuers U, Kupcinskas L. Efficacy and safety of ursodeoxycholic acid versus cholestyramine in intrahepatic cholestasis of pregnancy. Gastroenterology. 2005;129(3):894-901.

Glantz ZA, Marschall HU, Lammert F. Intrahepatic cholestasis of pregnancy: A randomised controlled trial comparing dexamethasone and UDCA. Hepatology. 2005;42:1399-405.

Hirvioja ML, Tuimala R, Vuori J. The treatment of intrahepatic cholestasis of pregnancy by dexamethasone.Br J Obstet Gynecol. 1992;99(2):109-11.

Modi N, Lewis H, Al-Naqeeb N. The effects of Repeated Antenatal Glucocorticoid Therapy on the Developing Brain Pediatr Res. 2001;50:581-5.

Marschall HU, Wagner M, Zollner G. Complementary stimulation of hepatobiliary transport and detoxification systems by rifampicin and ursodeoxycholic acid in humans. Gastroenterology. 2005;129(2):476-85.

Medina Lomelí JM, Medina Castro N. Intrahepatic cholestasis of pregnancy, an unpredictable fetal risk: report of a case and review of the literature. Ginecol Obstet Mex. 2000;68:486-8.

Heinonen S, Kirkinen P. Pregnancy outcome with intrahepatic cholestasis. Obstet Gynecol. 1999;94(2):189-93.