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

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

Publikationsverlauf

Eingereicht: 13. Januar 2021

Angenommen nach Revision: 05. Februar 2021

Artikel online veröffentlicht:
09. August 2021

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