Intrahepatic cholestasis of pregnancy

BMJ 1994;309:1243-1244 (12 November)

Editorials

Intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis of pregnancy is one of the few disordersthat adversely affect maternal wellbeing and fetal outcome.Early diagnosis and timely intervention can reduce perinatalmortality.

The condition is the most common liver disorder peculiar topregnancy and is second to viral hepatitis as a cause of jaundicein the third trimester. It is rarely reported except in Chile,Bolivia, Scandinavia, and China.¹ Its true incidence and rangeare unknown. Generalised pruritus, mild jaundice, and intrahepaticcholestasis in late pregnancy were reported by Ahlfeld in 1883²and later by Eppinger³ and Thorling.⁴ Svanborg also describedfatigue and mild abdominal pain and suggested that the conditionresolved rapidly after birth but tended to recur in successivepregnancies.⁵ Pruritus typically develops after 20 weeks ofpregnancy; is prominent on the arms, legs, and trunk; and progressesuntil delivery. Jaundice may develop two to four weeks laterwithout progressing.