View source for Intrahepatic cholestasis of pregnancy

== 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 &gt; 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

[[Category:Gastroenterology]]
[[Category:Obstetrical medicine]]