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Intrahepatic Cholestasis of Pregnancy

A Review of Diagnosis and Management

Wood, Amber M. MD*; Livingston, Elizabeth G. MD; Hughes, Brenna L. MD; Kuller, Jeffrey A. MD

Obstetrical & Gynecological Survey: February 2018 - Volume 73 - Issue 2 - p 103–109
doi: 10.1097/OGX.0000000000000524

Importance Intrahepatic cholestasis of pregnancy (ICP) complicates approximately 0.2% to 2% of pregnancies and can lead to increased fetal risks in pregnancy.

Objective This review aims to increase the knowledge of women's health care providers regarding the diagnosis, management, and fetal risks associated with ICP.

Results The diagnosis of ICP is based on symptoms of pruritus that typically include the palms and soles, as well as elevated bile acid levels. Other liver function tests such as alanine aminotransferase and aspartate aminotransferase are also frequently elevated, and other causes of liver dysfunction should be ruled out. Fetal risks of ICP include increased risk of preterm birth, meconium-stained amniotic fluid, respiratory distress syndrome, or stillbirth. There is evidence that as bile acid levels increase, so does the risk of adverse neonatal outcomes. Ursodeoxycholic acid treatment has been shown to improve maternal pruritus symptoms, as well as biochemical tests, but no treatment has been shown to definitively improve fetal outcomes.

Conclusions and Relevance Providers should be aware of the signs and symptoms of ICP and provide accurate diagnosis and management of affected women. Women with a diagnosis of ICP should be treated with ursodeoxycholic acid to improve maternal symptoms. Given the increased risk of stillbirth in the setting of ICP, delivery may be considered at 37 weeks' gestation.

Target Audience Obstetricians and gynecologists, family physicians.

Learning Objectives After completing this activity, the learner should be better able to identify symptoms of and diagnose ICP, counsel patients on neonatal risks associated with the diagnosis of ICP, and provide treatment for women with a diagnosis of ICP.

*Fellow, †Professor, and ‡Associate Professor, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC

The authors have disclosed that the US Food and Drug Administration has not approved the use of ursodeoxycholic acid for the treatment of intrahepatic cholestasis of pregnancy as discussed in this article. Please consult the product's labeling for approved information.

All authors, faculty, and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.

Correspondence requests to: Amber M. Wood, MD, DUMC 3967, Durham, NC 27710. E-mail:

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