Intrahepatic cholestasis of pregnancy. Diagnosis. Maternal and fetal complications

Abstract

Introduction. Intrahepatic cholestasis of pregnancy (ICP) is a cholestatic disorder characterized by pruritus, elevated serum aminotransferases and bile acid levels with onset in the second or third trimester of pregnancy, and spontaneous relief of signs and symptoms within two to three weeks after delivery. ICP has been observed in almost all ethnic groups, but there is relevant geographical variation in the incidence of ICP varying from less than 1% to 27.6%. It is important to diagnose it in time because of its effects on pregnancy outcome.Aim of the study. This review was undertaken to find the criteria of diagnosis and to evaluate the possible maternal and fetal complications. Materials and methods. To identify relevant articles, NCBI and ScienceDirect databases were searched using the Key words: “intrahepatic cholestasis of pregnancy”, “Idiopathic jaundice of pregnancy”, “Pruritus gravidarum”, “diagnosis of intrahepatic cholestasis of pregnancy”, “outcome on intrahepatic cholestasis of pregnancy”. Results. This study concluded that Pruritus is the primary clinical symptom of ICP. It usually presents in the third trimester, after 30 weeks of gestation, but rare cases developing early. The diagnosis of ICP is based on pruritus of cholestasis, elevated fasting serum bile acids > 10 μmol/L (± and elevated serum transaminases), spontaneous relief of signs and symptoms within two to three weeks after delivery and absence of other diseases that cause pruritus and jaundice. Mild jaundice with serum levels of conjugated bilirubin only moderately elevated occurs in 10 to 15% of cases. ICP presents a greater risk to the fetus than to the mother. ICP increases the rate of preterm delivery with the associated mortality and morbidity, meconium-stained amniotic fluid. In addition, the fetus seems to be at an increased risk for stillbirth. The major concern for the mother is for postpartum hemorrhage if her vitamin K level is low, leading to an increase in prothrombin time. Also women with ICP are more likely to have gestational diabetes, pre-eclampsia, spontaneous and iatrogenic preterm delivery, with increased rates of induction of labour. Conclusions. ICP, especially severe ICP is associated with adverse pregnancy outcome. Pregnant women should be diagnosed in an efficient time for adopting the appropriate management to prevent complications as much as possible.