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Adjuvant Use of Rifampin for Refractory Intrahepatic Cholestasis of Pregnancy

Liu, James, MD; Murray, Amanda M., DO; Mankus, Erin B., MD; Ireland, Kayla E., MD; Acosta, Ometeotl M., MD; Ramsey, Patrick S., MD, MSPH

doi: 10.1097/AOG.0000000000002794
Contents: Medical Disorders of Pregnancy: Case Report

BACKGROUND: Intrahepatic cholestasis of pregnancy is an incompletely understood disease that poses significant fetal risks, including stillbirth. Treatment of intrahepatic cholestasis of pregnancy is aimed at relieving maternal symptoms and improving fetal outcomes.

CASE: A 21-year-old gravid woman, 3 para 0111, presented at 27 2/7 weeks of gestation with severe intrahepatic cholestasis of pregnancy. Her clinical course was refractory to first-line therapy with ursodiol, and she was started on rifampin with rapid improvement of symptoms and transaminitis. Despite maternal improvement, she was delivered at 31 weeks of gestation for persistent nonreassuring fetal status.

CONCLUSION: Rifampin may be an effective adjunctive therapy for intrahepatic cholestasis of pregnancy refractory to ursodiol alone. Additional research is needed to assess short-term and long-term maternal and newborn outcomes, because fetal deterioration still occurred in spite of maternal improvement.

Rifampin may be an effective adjunctive therapy for intrahepatic cholestasis of pregnancy refractory to ursodiol alone.

Department of Obstetrics & Gynecology, Beaumont Health System, Royal Oak, Michigan; the Center for Pregnancy and Newborn Research, Department of Obstetrics & Gynecology, University of Texas Health Sciences Center at San Antonio, and the Department of Obstetrics & Gynecology, University Health System, San Antonio, Texas.

Financial Disclosure The authors did not report any potential conflicts of interest.

Each author has indicated that he or she has met the journal's requirements for authorship.

Corresponding author: James Liu, MD, Beaumont Health System, 3601 W 13 Mile Road, Royal Oak, MI 48073; email:

Received March 12, 2018

Received in revised form March 13, 2018

Accepted June 07, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.