Intrahepatic cholestasis of pregnancy



Introduction
Epidemiology
Clinical features
Management


Introduction

Intrahepatic cholestasis of pregnancy (also known as obstetric cholestasis) affects around 1% of pregnancies in the UK. It is associated with an increased risk of premature birth.

Epidemiology

  • Incidence: 30.00 cases per 100,000 person-years
  • Peak incidence: 30-40 years
Condition Relative
incidence
Intrahepatic cholestasis of pregnancy1
Atopic eruption of pregnancy0.30
<1 1-5 6+ 16+ 30+ 40+ 50+ 60+ 70+ 80+

Clinical features

Features
  • pruritus - may be intense - typical worse palms, soles and abdomen
  • clinically detectable jaundice occurs in around 20% of patients
  • raised bilirubin is seen in > 90% of cases

Management

Management
  • induction of labour at 37 weeks is common practice but may not be evidence based
  • ursodeoxycholic acid - again widely used but evidence base not clear
  • vitamin K supplementation