Cholestasis of Pregnancy

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, 2020 Zonal Avenue, IRD, Room 203, Los Angeles, CA 90033, USA.
Obstetrics and Gynecology Clinics of North America (Impact Factor: 1.38). 06/2010; 37(2):269-82. DOI: 10.1016/j.ogc.2010.02.011
Source: PubMed


Intrahepatic cholestasis (ICP) of pregnancy is a disease that is likely multifactorial in etiology and has a prevalence that varies by geography and ethnicity. The diagnosis is made when patients have a combination of pruritus and abnormal liver-function tests. It is associated with a high risk for adverse perinatal outcome, including preterm birth, meconium passage, and fetal death. As of yet, the cause for fetal death is unknown. Because fetal deaths caused by ICP appear to occur predominantly after 37 weeks, it is suggested to offer delivery at approximately 37 weeks. Ursodeoxycholic acid appears to be the most effective medication to improve maternal pruritus and liver-function tests; however, there is no medication to date that has been shown to reduce the risk for fetal death.

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    • "Although there are confl icting data regarding the eff ects of UDCA treatment on the perinatal outcome, several clinical trials and observational studies showed that UDCA treatment improved fetal outcomes (Palma et al. 1997; Bacq et al. 2012). On the other hand, some studies emphasised that, while pruritus and serum levels of total bile salts and ALT improved, perinatal outcomes with respect to the eff ect of UDCA are less clear (Pathak et al. 2010). We cannot, however, comment on this subject, as we administered UDCA treatment to all of our patients. "
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    ABSTRACT: The aim of this study was to describe maternal and fetal characteristics associated with intrahepatic cholestasis of pregnancy (ICP) and to determine clinical and biochemical predictors of fetal complications. A total of 89 singleton pregnancies with ICP were analysed, retrospectively. All data concerning laboratory results, symptom onset time, treatment response, delivery time and infant information were recorded in the study protocol. The mean gestational age at diagnosis was 32.6 ± 3.4 weeks; mean time of delivery was 36.8 ± 1.9 weeks. Binary logistic regression revealed that gestational age at diagnosis was predictive of preterm delivery (OR = 2.3, 95% CI: 1.5-3.3, p = 0.001). The incidence of respiratory distress syndrome (RDS), fetal growth restriction, fetal distress and preterm delivery were significantly higher in patients who were diagnosed before 30 weeks than after 34 weeks' gestation (p < 0.01). Gestational age at diagnosis is an important independent factor predicting adverse perinatal outcomes in patients with ICP.
    Journal of Obstetrics and Gynaecology 11/2014; 35(4):1-4. DOI:10.3109/01443615.2014.968102 · 0.55 Impact Factor
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    • "ICP is transient and generally has a benign course in mothers but may adversely affect the prognosis of the fetus. The major adverse fetal outcomes were reported as preterm delivery, meconium staining of the amniotic fluid or membranes, fetal distress, respiratory distress syndrome, asphyxia, bradycardia, and intrauterine fetal death (IUFD) [10] [20] [23] . The exact mechanism underlying is not clear yet; also, any specific markers and/or methods for the prediction of adverse fetal outcomes especially for IUFD, the most dreadful complication, still needs to be determined. "
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    ABSTRACT: Abstract Aim: Our aim was to investigate whether any hematological changes readily detectable by simple complete blood count (CBC), as well as fasting and postprandial total serum bile acid (SBA) levels, have diagnostic values for the prediction of adverse pregnancy outcomes in intrahepatic cholestasis of pregnancy (ICP). Methods: A prospective, case control study was carried out including 217 pregnant women (117 women with ICP and 100 healthy controls). The main outcome measures investigated were preterm delivery, APGAR scores, and neonatal unit admission. A multivariate logistic regression model was used to identify the independent risk factors of adverse pregnancy outcomes. Results: Compared with controls, women with ICP had significantly higher mean platelet volume (MPV) (mean 10.2±1.0 vs. 11.0±1.3; P<0.001) and platelet distribution width (PDW) (mean 13.1±2.3 vs. 14.7±2.8; P<0.001) values. Analysis with logistic regression revealed that the probability of preterm delivery did not increase until MPV levels exceeded 11.2 fL [odds ratio (OR)=2.68, 95% confidence interval (CI)=1.13-6.32, P=0.025], and total bilirubin levels exceeded 0.6 mg/dL (OR=3.13, 95% CI=1.21-8.09, P=0.019). Considering the low APGAR scores, only increased postprandial total SBA levels of ≥51 μmol/L were found to be predictive significantly (OR=3.02, 95% CI=1.07-8.53, P=0.037). Conclusions: Our study suggests that increased MPV and total bilirubin levels are associated with preterm delivery, and increased postprandial total SBA levels are predictive for low APGAR in ICP patients.
    Journal of Perinatal Medicine 10/2014; DOI:10.1515/jpm-2014-0207 · 1.36 Impact Factor
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    ABSTRACT: Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-associated liver disease of unknown etiology. The aim of this study was to investigate the change in maternal and fetal adrenal function in clinical and experimental ICP. The maternal and fetal serum levels of cortisol and dehydroepiandrosterone sulfate (DHEAS) were determined in 14 women with ICP and in pregnant rats with estrogen-induced intrahepatic cholestasis. In women with ICP, the fetal serum cortisol and DHEAS levels were significantly higher than those in women with normal pregnancy, after correcting the impact of gestational age at delivery. The relationship between fetal cortisol and maternal cholic acid levels was bidirectional; the fetal cortisol tended to increase in mild ICP, while it decreased in severe ICP. In pregnant rats with estrogen-induced cholestasis, the fetal cortisol level was significantly lower in the group with oxytocin injection, compared with the group without oxytocin injection (191.92±18.86 vs. 272.71±31.83 ng/ml, P<0.05). In contrast, the fetal cortisol concentration was increased after oxytocin injection in normal control rats. The data indicate that fetal stress-responsive system is stimulated in mild ICP, but it is suppressed in severe ICP, which might contribute to the occurrence of unpredictable sudden fetal death. Further studies are warranted to explore the role of impaired fetal adrenal function in the pathogenesis of ICP and the clinical implications.
    Medical science monitor: international medical journal of experimental and clinical research 05/2011; 17(5):CR265-71. DOI:10.12659/MSM.881766 · 1.43 Impact Factor
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