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Cholestasis of Pregnancy, Intrahepatic

Anne M. Valeri White, DO, FAAFP and Lynn M. Hamrich, MD, FAAFP Reviewed 06/2019
 


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 accompanied by elevated serum bile acid levels 
  • Rare cases have been reported in the 1st trimester (1),(3).

  • Pruritus ...

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
Floreani A, Gervasi MT. New insights on intrahepatic cholestasis of pregnancy. Clin Liver Dis.  2016;20(1):177–189. [View Abstract on OvidMedline]
2
Ovadia C, Williamson C. Intrahepatic...

ADDITIONAL READING

  • Brouwers L, Koster MP, Page-Christiaens GC, et al. Intrahepatic cholestasis of pregnancy: maternal and fetal outcomes associated with elevated bile acid levels. Am J Obstet Gynecol....

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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