Intrahepatic Cholestasis of Pregnancy

Intrahepatic cholestasis of pregnancy (ICP) results from failure of the liver to excrete bile acids appropriately. Although the cause has not been clearly delineated, hormonal and genetic factors are suspected. ICP is more common in women with a family history of the disease and in women who have had cholestasis while taking oral contraceptives. The disorder also tends to recur in subsequent pregnancies.

Despite the fact that the disease is usually referred to as benign, an increased incidence of preterm labor, stillbirths, fetal distress, and meconium staining has been reported with ICP. Affected women should therefore be treated at centers capable of caring for premature infants. Increased postpartum bleeding may result from decreased absorption of vitamin K.

ICP typically occurs during the third trimester and is characterized by generalized pruritus, which may be severe and is often worse at night. Twenty percent to 60% of women may subsequently develop jaundice.

Laboratory data reveal elevated serum bilirubin concentration, but usually below 6 mg per deciliter. Liver tests reflect cholestasis without significant evidence of hepatocellular injury.

Symptomatic relief of pruritus may be achieved with the bile salt-binding resin cholestyramine. Patients should be followed closely for signs of preterm labor and fetal well-being. Prophylactic vitamin K should be administered to prevent increased bleeding.