Cholestasis of pregnancy is a disorder characterized by generalized itching of the skin.
It usually appears during the third trimester of pregnancy and disappears after delivery. In addition, the incidence is higher in Latin American pregnant women, multiple pregnancies, by in vitro fertilization, and in pregnant women who have already had cholestasis in a previous pregnancy.
It manifests with itchy skin that typically affects the palms of the hands and soles of the feet. The itching is usually nocturnal and can be so intense that it makes it difficult to sleep. It does not imply risks to the health of the pregnant woman, but it can carry a risk for the fetus in the form of premature labor, meconium and stillbirth.
Diagnosis is based on history and physical examination. In the analysis of blood and urine, an elevation of bile acids can be evidenced.
Ursodeoxycholic acid is the treatment of choice, and is associated with a clear improvement in both symptoms and laboratory abnormalities. In more severe cases, premature termination of pregnancy may be necessary.
- Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results of aggregate and individual patient data meta-analyses. Lancet 2019
- Kong X et al. Evaluating the effectiveness and safety of ursodeoxycholic acid in treatment of intrahepatic cholestasis of pregnancy: A meta-analysis (a prisma-compliant study). Medicine 2016
- Puljic, A et al. The risk of infant and fetal death by each additional week of expectant management in intrahepatic cholestasis of pregnancy by gestational age. AJOG 2015 C
