Management of Intrahepatic Cholestasis of Pregnancy: Recommendations of the Working Group on Obstetrics and Prenatal Medicine – Section on Maternal Disorders

Carsten Hagenbeck; Amr Hamza; Sven Kehl; Holger Maul; Frank Lammert; Verena Keitel; Matthias C. Hütten; Ulrich Pecks

doi:10.1055/a-1386-3912

Geburtshilfe und Frauenheilkunde, Table of Contents

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

¹Universitätsklinikum Düsseldorf, Frauenklinik, Düsseldorf, Germany

,

Amr Hamza

²Universitätsklinikum des Saarlandes, Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Homburg, Germany

³Kantonsspital Baden AG, Baden, Switzerland

,

Sven Kehl

⁴Frauenklinik, Friedrich Alexander University Erlangen Nuremberg, Faculty of Medicine, Erlangen, Germany

,

Holger Maul

⁵Section of Prenatal Disgnostics and Therapy, Asklepios Klinik Barmbek, Hamburg, Germany

,

Frank Lammert

⁶Klinik für Innere Medizin II, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany

,

Verena Keitel

⁷Universitätsklinikum Düsseldorf, Klinik für Gastroenterologie, Hepatologie und Infektiologie, Düsseldorf, Germany

,

Matthias C. Hütten

⁸Clinique E2 Neonatology, Maastricht Universitair Medisch Centrum+, Maastricht, Netherlands

,

Ulrich Pecks

⁹Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Gynäkologie und Geburtshilfe, Kiel, Germany

› Author Affiliations

Abstract

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

Full Text

References

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