Intrahepatic cholestasis of pregnancy (also known as obstetric cholestasis) affects around 1% of pregnancies in the UK. It is associated with an increased risk of premature birth.

Features

• pruritus - may be intense - typical worse palms, soles and abdomen
• clinically detectable jaundice occurs in around 20% of patients
• raised bilirubin is seen in > 90% of cases

Management

• induction of labour at 37-38 weeks is common practice but may not be evidence based
  • Intrahepatic cholestasis of pregnancy is commonly cited to put women at increased risk of stillbirth, due to elevated levels of circulating bile acids.
• ursodeoxycholic acid - again widely used but evidence base not clear
• vitamin K supplementation - as gall bladder blocked, therefore cant reabsorb fat soluble vits

Recurrence of intrahepatic cholestasis of pregnancy is 45-90% in subsequent pregnancies.