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Obstetric cholestasis

BMJ 2002; 324 doi: (Published 19 January 2002) Cite this as: BMJ 2002;324:123

May have serious consequences for the fetus, and needs to be taken seriously

  1. Piotr Milkiewicz, registrar,
  2. Elwyn Elias, consultant hepatologist,
  3. Catherine Williamson, Wellcome advanced clinical fellow,
  4. Judith Weaver, consultant obstetrician
  1. Liver and Hepatobiliary Unit, Queen Elizabeth Hospital, Birmingham B15 2TH
  2. Maternal and Fetal Disease Group, Imperial College School of Medicine, London W12 0NN
  3. Birmingham Women's Hospital, Birmingham B15 2TG

    Obstetric cholestasis (or intrahepatic cholestasis of pregnancy) remains widely disregarded as an important clinical problem, with many obstetricians still considering its main symptom, pruritus, a natural association of pregnancy. Obstetric cholestasis is associated with cholesterol gallstones. It may be extremely stressful for the mother but also carries risks for the baby.

    Clinical studies clearly show that when obstetric cholestasis complicates pregnancies it may lead to premature births in up to 60%, fetal distress in up to 33%, and intrauterine death in up to 2% of patients.1 The cause of fetal death is acute anoxia.2 The incidence of obstetric cholestasis varies from 0.1% to 1.5% of pregnancies in Europe and 9.2%-15.6% in South American countries such as Bolivia or Chile. It is particularly high in the native Araucanian population in Chile, where the proportion of affected pregnancies reaches nearly 28%.3 The low quoted incidence of obstetric cholestasis in Europe may reflect an underestimation of the problem, and growing awareness of the condition will probably increase the numbers. For example, early studies from North America, published in 1962, showed its incidence to be less than 0.1%, whereas a study published 17 years later estimated the incidence to be around …

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