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Cholestasis of Pregnancy, Intrahepatic

Asma Tariq, MD, Sparghai Sahar Ludin, MD and Mario Martinez, MD Reviewed 05/2023
 


BASICS

DESCRIPTION

  • Intrahepatic cholestasis of pregnancy (ICP) is the most common pregnancy-specific liver disorder characterized by new-onset pruritus that often starts on the palms and soles before b...

DIAGNOSIS

HISTORY

  • Pruritus that is worse at night, improved with cold temperatures, and progressive with advancing gestational age (1,2)

  • Onset of pruritus often precedes the elevation in bile acids (2...

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
...

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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