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CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2021; 81(08): 922-939
DOI: 10.1055/a-1386-3912
GebFra Science
Review/Übersicht

Management der intrahepatischen Schwangerschaftscholestase (Intrahepatic Cholestasis of Pregnancy – ICP): Empfehlungen der Arbeitsgemeinschaft Geburtshilfe und Pränatalmedizin (AGG – Sektion Maternale Erkrankungen)

Article in several languages: English | deutsch
Carsten Hagenbeck
1   Universitätsklinikum Düsseldorf, Frauenklinik, Düsseldorf, Germany
,
Amr Hamza
2   Universitätsklinikum des Saarlandes, Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Homburg, Germany
3   Kantonsspital Baden AG, Baden, Switzerland
,
Sven Kehl
4   Frauenklinik, Friedrich Alexander University Erlangen Nuremberg, Faculty of Medicine, Erlangen, Germany
,
Holger Maul
5   Section of Prenatal Disgnostics and Therapy, Asklepios Klinik Barmbek, Hamburg, Germany
,
Frank Lammert
6   Klinik für Innere Medizin II, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany
,
Verena Keitel
7   Universitätsklinikum Düsseldorf, Klinik für Gastroenterologie, Hepatologie und Infektiologie, Düsseldorf, Germany
,
Matthias C. Hütten
8   Clinique E2 Neonatology, Maastricht Universitair Medisch Centrum+, Maastricht, Netherlands
,
Ulrich Pecks
9   Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Gynäkologie und Geburtshilfe, Kiel, Germany
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Zusammenfassung

Die Schwangerschaftscholestase (Intrahepatic Cholestasis of Pregnancy, ICP) ist die häufigste schwangerschaftsspezifische Lebererkrankung. Das Leitsymptom Juckreiz und eine begleitende Konzentrationserhöhung von Gallensäuren im Serum und/oder der Alanin-Aminotransferase (ALT) sind richtungsweisend für die Diagnosestellung. Insgesamt ist die mütterliche Prognose gut. Das fetale Outcome ist abhängig von der Gallensäurenkonzentration. Die ICP ist sowohl mit einer Frühgeburt als auch mit dem intrauterinem Fruchttod (IUFT) assoziiert. Ursächlich ist eine akute fetale Asphyxie und nicht eine chronische uteroplazentare Dysfunktion. Daher ist ein prädiktives Monitoring, z. B. durch CTG oder Ultraschall nicht möglich. Eine medikamentöse Therapie mit Ursodeoxycholsäure (UDCA) bessert den Juckreiz – beeinflusst jedoch das fetale Outcome nicht nachweislich. Eine Entbindungsindikation ergibt sich in Abhängigkeit der Gallensäurenkonzentration und des Gestationsalters. In Folgeschwangerschaften besteht ein hohes Wiederholungsrisiko.

Schlüsselwörter

Totgeburt - Weheneinleitung - Gallensäuren - Lebererkrankung - Ursodeoxycholsäure - Pruritus


Publication History

Received: 13 January 2021

Accepted after revision: 05 February 2021

Article published online:
09 August 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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