gynecology and obstetrics
Hepatic Disorders in Pregnancy
Intrahepatic cholestasis (pruritus) of pregnancy
This relatively common disorder apparently results from idiosyncratic exaggeration of normal bile stasis due to hormonal changes. Incidence varies based on ethnicity and is highest in Bolivia and Chile. Consequences of intrahepatic cholestasis include increased risk of Preterm Infants None Stillbirth None Passage of stool (meconium) by the fetus before birth, which can lead to Meconium Aspiration Syndrome None Intense pruritus, the earliest symptom, develops during the 2nd or 3rd trimester; dark urine and jaundice sometimes follow. Acute pain and systemic symptoms are absent. Intrahepatic cholestasis usually resolves after delivery but tends to recur with each pregnancy or with use of oral contraceptives. Intrahepatic cholestasis is suspected based on symptoms. The most sensitive and specific laboratory finding is a fasting total serum bile acid level of > 10 mmol/L. This finding may be the only biochemical abnormality present. Fetal demise is more likely when the fasting total bile acid level is > 40 mmol/L. (UDCA) 5 mg/kg orally 2 or 3 times a day (or up to 7.5 mg/kg twice a day) is the drug of choice. It helps lessen the severity of symptoms and normalize biochemical markers of liver function; however, it does not decrease the incidence of fetal complications. Definitive treatment is delivery of the fetus. The American College of Obstetricians and Gynecologists (ACOG)/Society for Maternal-Fetal Medicine (SMFM) recommends ( General reference ) For patients with total bile acid levels < 100 micromol/L, delivery at 36 to 39 weeks gestation or at diagnosis if diagnosed at > 39 weeks For patients with total bile acid levels ≥ 100 micromol/L, delivery at 36 weeks gestation or at diagnosis if diagnosed later 