Chapter category: Gastroenterology
Intrahepatic Cholestasis of Pregnancy
Maternal Liver Disease
Edited by: Jamal IbdahISBN: 1-58706-192-9
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Chapter authors:
Paul A. Dawson and Girish Mishra
Intrahepatic cholestasis of pregnancy (ICP), also known as obstetric cholestasis, is one of the most common causes of liver disease in pregnancy. ICP is a reversible form of cholestasis that usually develops in the third trimester of pregnancy and is associated with itching, elevated serum levels of bile acids, abnormal liver function tests, and mild changes in liver histology. These symptoms persist until delivery, after which the condition rapidly resolves. ICP is largely a clinical diagnosis, and is made by a suggestive history and exclusion of other causes of cholestasis. While ICP is considered a benign disease with a good prognosis for the mother, ICP is associated with poor fetal outcomes and perinatal mortality in untreated cases as high as 11% to 20%. The etiology of ICP is unclear, but undoubtedly involves genetic and hormonal factors. Recent genetic studies have implicated gene mutations in the liver canalicular phospholipid transporter, MDR3, however these mutations can account for only a small percentage of ICP cases. Current evidence suggests a possible abnormality in the metabolism of progesterone and bile acids leading to elevated maternal serum bile acids and impaired transport of bile acids across the placenta from the fetal to the maternal circulation. However, it is not known how this increased fetal bile acid burden leads to the complications of perinatal mortality, preterm delivery, abnormal intrapartum fetal heart rate rhythm, and meconium passage. Ursodeoxycholic acid (UDCA) is currently the most efficacious medical intervention. UDCA therapy relieves maternal symptoms, reduces serum liver enzymes and, more importantly, may also protect the fetus from bile acid toxicity and improve fetal survival. Due to the increased risk of stillbirth in ICP, most experienced centers advocate delivery by the 37th week of gestation.
Additional chapters from this book:
Acute Fatty Liver of Pregnancy
Jerry Angdisen and Jamal A. Ibdah
Acute fatty liver of pregnancy (AFLP) is a serious maternal illness occurring in the third trimester of pregnancy with significant perinatal and maternal mortality. Till recently, it has been co...
Preeclamptic Liver Disease and HELLP Syndrome
Gretchen Koontz, Jamal Ibdah, and David C. Merrill
Hypertensive disorders of pregnancy remain a devastating disease for both the mother and the fetus. Preeclampsia and HELLP syndrome, two disorders specific to pregnancy, remain a major cause o...
Intrahepatic Cholestasis of Pregnancy
Paul A. Dawson and Girish Mishra
Intrahepatic cholestasis of pregnancy (ICP), also known as obstetric cholestasis, is one of the most common causes of liver disease in pregnancy. ICP is a reversible form of cholestasis that u...
Spectrum of Maternal Liver Disease
R. Sidney G. Smith and Jamal A. Ibdah
There is a broad range of liver diseases that can occur during the course of pregnancy, including disease states which are specific to pregnancy and those which occur coincidentally with pregnancy. ...
Hyperemesis Gravidarum and Maternal Liver Disease
William M. Outlaw, Jamal A. Ibdah and Kenneth L. Koch*
Hyperemesis gravidarum (HG) is the most severe form of illness within the spectrum of nausea and vomiting of pregnancy (NVP). HG affects millions of pregnant women annually, imparts significant cost...
The Liver in Normal Pregnancy
Yannick Bacq
Changes in value of certain serum liver function tests occur during normal pregnancy and an understanding of these physiological changes is necessary for the management of liver diseases. Because of...
