Intrahepatic cholestasis of pregnancy
From IDWiki
Clinical Manifestations
- Pruritus, especially of palms and soles, without rash
- Typically occurs in second half of pregnancy
- Liver is not tender
- Usually has a family history
- More common in Sweden and Chile
Differential Diagnosis
- Pemphidois gestationis: typically has a rash
- Pruritic urticarial papules of pregnancy (PUPP): has urticaria
Diagnosis
- Exclude other causes
- Abdominal ultrasuond should be normal
- Liver panel may show elevated AST/ALT (can be very high), but should have normal bilirubin and GGT
- Fasting bile acids > 10 for diagnosis, but takes up to 5 days
Management
- Ursodeoxycholic acid 10-15 mg/kg/day
- Typical dose 250-500 mg po BID
- Takes a few days to have an effect
- Can also trial antihistamines, benzodiazepines, vitamin K, and topical creams
- Cholestyramine is not helpful
- Try to deliver around 38 weeks, given low (but real) risk of complications
Prognosis and Complications
- Complications are proportional to the level of bile acids
- Stillbirth in less than 1%
- Prematurity
- Meconium aspiration
