Intrahepatic Cholestasis of Pregnancy

Fetal complications include distress, preterm delivery, heart rate abnormalities, meconium stained fluid, and intrauterine demise at a rate of 10% to 15%.1 Associated mild jaundice is found in 10%-15% of cases and may have associated anorexia, malaise, or abdominal pain.3 Other comorbidities may include preeclampsia, acute fatty liver of pregnancy, and gestational diabetes.1,2 Risk factors for ICP include certain ethnic backgrounds; for example, Sweden and Chile report much higher rates. Presenting symptoms Lab values Diagnosis Management in pregnancy Reasoning Follow up Localized pruritus on palms and soles of feet that generalizes to total body, worsening at nightMay also haveAnorexiaAbdominal painDark urineExcoriation from scratchingMalaisePale stoolJaundice Elevated:Total serum bile acidsBilirubinAlanine aminotransferaseAspartate aminotransferaseAlkaline phosphataseGamma glutamyl transferase (an indicator of hepatocellular damage)3Prothrombin timePartial prothromboplastin time Intrahepatic cholestasis of pregnancy Ursodeoxycholic acid 15 mg/kg/dHydroxyzine 25-50 mg/day ORBenadryl 25-50 mg PO every 4 to 6 hoursVitamin D 25 mg PO every 6 to 8 hours (max of 500 mg/daily)Refer to obstetrical provider Restore normal serum bile acid levels in the placentaImprove pruritusMay improve pruritusAntepartum testing & timing of delivery Liver function tests 6-8 weeks after birth Table 1 Intrahepatic Cholestasis of Pregnancy Diagnosis & Treatment