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

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

Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disease specific to pregnancy. The cardinal symptom of pruritus and a concomitant elevated level of bile acids in the serum and/or alanine aminotransferase (ALT) are suggestive for the diagnosis. Overall, the maternal prognosis is good. The fetal outcome depends on the bile acid level. ICP is associated with increased risks for adverse perinatal outcomes, including preterm delivery, meconium-stained amniotic fluid, and stillbirth. Acute fetal asphyxia and not chronic uteroplacental dysfunction leads to stillbirth. Therefore, predictive fetal monitoring is not possible. While medication with ursodeoxycholic acid (UDCA) improves pruritus, it has not been shown to affect fetal outcome. The indication for induction of labour depends on bile acid levels and gestational age. There is a high risk of recurrence in subsequent pregnancies.

Key words

stillbirth - induction of labour - bile acids - liver disease - ursodeoxycholic acid - pruritus

Full Text

References

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