Cholestasis of pregnancy

Area of Science:

• Obstetrics and Gynecology
• Hepatology
• Maternal-Fetal Medicine

Background:

• Cholestasis of pregnancy is the most frequent liver disease specific to pregnancy.
• It presents with maternal pruritus (itching) in late pregnancy, elevated serum bile acids, and potential liver function test abnormalities.
• Abdominal pain and liver failure are not characteristic features.

Purpose of the Study:

• To summarize the characteristics, diagnosis, management, and outcomes of cholestasis of pregnancy.
• To highlight the fetal risks associated with this condition.
• To review the potential benefits of ursodeoxycholic acid treatment.

Main Methods:

• Diagnosis relies on clinical history, exclusion of other conditions via serology, and upper abdominal ultrasound.
• Management involves delivery at 38 weeks gestation to mitigate fetal risks.
• Preliminary studies evaluated ursodeoxycholic acid for symptomatic and biochemical improvement.

Main Results:

• The condition is linked to a five-fold increased risk of stillbirth, intrapartum fetal distress, and preterm labor.
• Delivery at 38 weeks has reduced adverse fetal outcomes.
• Ursodeoxycholic acid demonstrated symptomatic and biochemical improvements in preliminary studies, with potential for improved fetal outcomes.

Conclusions:

• Cholestasis of pregnancy requires prompt diagnosis and management, typically involving delivery at 38 weeks.
• Ursodeoxycholic acid is a promising treatment option, especially for early-presenting cases.
• Continued research is needed to understand the unpredictable nature and precise mechanisms of fetal risk.