Cholestasis of pregnancy

Background
  • Caused by combination of hormonal, genetic, and environmental factors --> impaired bile flow --> deposition of bile salts in skin and placenta
  • May predispose mothers to vitamin K deficiency and increase risk of preterm delivery, IUFD, and neonatal respiratory distress syndrome[1]

Clinical Features
  • Typically develops in late second and/or 3rd trimester
  • Rapidly resolves after delivery
  • Pruritus, starts and predominates on palms and soles
  • RUQ pain
  • Nausea
  • Jaundice

Differential Diagnosis
  • Liver disease in pregnancy:
  • Pregnancy-specific pruritus (see also: Rashes of pregnancy)
    • Pruritus gravidarum
    • Atopic eruption of pregnancy
    • Polymorphic eruption of pregnancy
    • Pemphigoid gestationis
    • Prurigo of pregnancy
    • Pruritic folliculitis of pregnancy

Evaluation
  • CBC (rule out thrombocytopenia)
  • LFTs
    • Elevated total bile acid concentration
    • Aminotransferases usually <2x upper limit of normal
    • Alk phos and bili may be elevated
    • GGT normal or modestly elevated
    • RUQ US normal, no biliary duct dilation

Management
  • Ursodeoxycholic acid (ursodiol) 300mg TID until delivery
  • OBGYN follow-up

Disposition
  • Discharge with OBGYN follow-up

See Also



References

https://www.uptodate.com/contents/intrahepatic-cholestasis-of-pregnancy

  1. http://bestpractice.bmj.com/topics/en-us/800
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