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Cholestasis of Pregnancy, Intrahepatic

Anne M. Valeri White, FAAFP, DO and Lynn M. Hamrich, FAAFP, MD Reviewed 06/2021
 


BASICS

DESCRIPTION

  • Intrahepatic cholestasis of pregnancy (ICP) is characterized by generalized pruritus without skin lesions in pregnancy, accompanied by elevated serum bile acid levels +/− elevated se...

DIAGNOSIS

HISTORY

Intense pruritus beginning in the 2nd or 3rd trimester of pregnancy commonly accompanied by elevated serum bile acid levels 
  • Rare cases have been reported in the 1st trimester (2).

  • Pru...

TREATMENT

GENERAL MEASURES

Medications to normalize serum bile acid levels are for symptomatic control only. 

MEDICATION

First Line

Ursodeoxycholic acid (UDCA, ursodiol, Actigall) is a bile acid that occu...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Repeat serum bile acid levels and liver function tests 6 to 12 weeks after delivery.

  • Persistent lab abnormalities or symptoms necessitate gastroenterology referral...

REFERENCES

1
Menżyk T, Bator M, Derra A, et al. The role of metabolic disorders in the pathogenesis of intrahepatic cholestasis of pregnancy Clin Exp Hepatol. 2018;4(4):217–223.
2
Smith D, Rood K. Intrah...

ADDITIONAL READING

  • Brouwers  L, Koster  MP, Page-Christiaens  GC, et al. Intrahepatic cholestasis of pregnancy: maternal and fetal outcomes associated with elevated bile aci...

CODES

ICD10

  • K83.1 Obstruction of bile duct

  • O26.619 Liver and biliary tract disord in pregnancy, unsp trimester

  • O26.611 Liver and biliary tract disord in pregnancy, first trimester

  • O26.612 Liver and biliar...

CLINICAL PEARLS

  • Consider ICP in pregnant women with diffuse itching in the absence of rash.

  • Serum bile acids are the most sensitive laboratory test for ICP, but liver function tests may also be abnorma...

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