Editorials

Intrahepatic cholestasis of pregnancy

BMJ 1994; 309 doi: http://dx.doi.org/10.1136/bmj.309.6964.1243 (Published 12 November 1994) Cite this as: BMJ 1994;309:1243
  1. E A Fagan

    Intrahepatic cholestasis of pregnancy is one of the few disorders that adversely affect maternal wellbeing and fetal outcome. Early diagnosis and timely intervention can reduce perinatal mortality.

    The condition is the most common liver disorder peculiar to pregnancy and is second to viral hepatitis as a cause of jaundice in the third trimester. It is rarely reported except in Chile, Bolivia, Scandinavia, and China.1 Its true incidence and range are unknown. Generalised pruritus, mild jaundice, and intrahepatic cholestasis in late pregnancy were reported by Ahlfeld in 18832 and later by Eppinger3 and Thorling.4 Svanborg also described fatigue and mild abdominal pain and suggested that the condition resolved rapidly after birth but tended to recur in successive pregnancies.5 Pruritus typically develops after 20 weeks of pregnancy; is prominent on the arms, legs, and trunk; and progresses until delivery. Jaundice may develop two to four weeks later without progressing.

    The pathogenesis of intrahepatic cholestasis of pregnancy is unclear. Multiple factors probably interact with a genetic predisposition to alter the membrane composition of bile ducts and hepatocytes and increase their sensitivity to sex steroids. …

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