Cholestasis of pregnancy

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Background

  • characterized by pruritus and elevation in serum bile acid concentrations, typically developing in late second and/or third trimester and rapidly resolving after delivery

Clinical Features

  • pruritus, starts and predominates on palms and soles
  • RUQ abd pain
  • Nausea
  • Jaundice

Differential Diagnosis

  • Liver disease in pregnancy
    • acute fatty liver of pregnancy
    • hemolysis, elevated liver enzymes and low platelets syndrome
    • hyperemesis gravidarum
  • Pregnancy specific pruritus
    • Pruritus gravidarum
    • Atopic eruption of pregnancy
    • Polymorphic eruption of pregnancy
    • Pemphigoid gestations
    • Prurigo of pregnancy
    • Pruritic folliculitis of pregnancy

Evaluation

  • increase in serum total bile acid concentration
  • increase in serum aminotransferases usually less than two times upper limit of normal
  • alk phos and bili can be elevated as well
  • GGT is normal or modestly elevated
  • US is normal, biliary ducts not dilated

Management

  • Ursodeoxycholic acid 300mg TID until delivery
  • OBGYN follow-up

Disposition

  • home with OBGYN follow-up

See Also

External Links

References

https://www.uptodate.com/contents/intrahepatic-cholestasis-of-pregnancy

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