Intrahepatic Cholestasis of Pregnancy

Abstract

Intrahepatic cholestasis of pregnancy is characterized by pruritus, elevated bile acids and liver enzymes, and occasionally jaundice. It has specific implications for maternal and perinatal outcomes. Symptomatic and therapeutic treatment with ursodeoxycholic acid is usually initiated. Bile acid levels in their initial and serial determination can assist with antepartum management. Preterm delivery, meconium-stained amniotic fluid, and respiratory distress commonly complicate these pregnancies. The difficulty in predicting and preventing unanticipated fetal death near term drives the obstetrician's desire to deliver infants before 38 weeks. The neonatologist in turn manages potential complications related to prematurity and the compounding negative effect of bile acids on respiratory function. The pathophysiology of elevated maternal bile acid levels on the fetal lung should prompt a high level of care and attention during the first hours after birth in all newborn infants born to women with intrahepatic cholestasis of pregnancy.