Cholestasis of pregnancy

Revision as of 19:19, 23 August 2019 by ClaireLewis (talk | contribs) (Differential Diagnosis)


  • Caused by combination of hormonal, genetic, and environmental factors --> impaired bile flow --> deposition of bile salts in skin and placenta
  • May predispose mothers to vitamin K deficiency and increase risk of preterm delivery, IUFD, and neonatal respiratory distress syndrome[1]

Clinical Features

  • Typically develops in late second and/or 3rd trimester
  • Rapidly resolves after delivery
  • Pruritus, starts and predominates on palms and soles
  • RUQ pain
  • Nausea
  • Jaundice

Differential Diagnosis


  • CBC (rule out thrombocytopenia)
  • LFTs
    • Elevated total bile acid concentration
    • Aminotransferases usually <2x upper limit of normal
    • Alk phos and bili may be elevated
    • GGT normal or modestly elevated
    • RUQ US normal, no biliary duct dilation


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


  • Discharge with OBGYN follow-up

See Also

External Links