Intrahepatic cholestasis of pregnancy and coagulation: a dual risk of hypercoagulability and bleeding

Intrahepatic cholestasis of pregnancy (ICP) is a hepatobiliary disorder characterized by elevated bile acid levels and liver dysfunction and usually occurs in the third trimester. Although the ICP has been associated with various fetal complications, its effects on maternal coagulation are poorly understood. Recent studies suggest that ICP may both cause hypercoagulability and increase bleeding tendency by impairing the synthesis of clotting factors. The aim of this study was to evaluate the relationships between ICP and coagulation parameters and to examine their potential clinical implications.

This retrospective case‒control study included 175 pregnant women with ICP and 162 healthy women matched for gestational age. Demographic, biochemical and hematologic parameters were analyzed. The prothrombin time (PT), activated partial thromboplastin time (aPTT), international normalized ratio (INR) and fibrinogen levels were evaluated.

Fibrinogen levels were significantly greater in the ICP group (p < 0.01), but PT, aPTT and INR values were not significantly different (p > 0.05). In the postpartum period, 2 cases of venous thromboembolism (VTE) were observed in the ICP group, whereas no cases of VTE were observed in the control group. Furthermore, the mean gestational age at delivery was significantly lower in ICP patients (253.75 ± 15.53 days vs. 271.43 ± 10.26 days, p < 0.01). Fetal complication rates were also significantly higher; the most common complications were fetal distress (7.4%), meconium aspiration (6.3%), preterm labor (4.0%) and fetal growth restriction (FGR) (2.9%).

In ICP patients, hypercoagulability is a clinically significant concern that should be considered alongside bleeding risk. In our study, no significant differences were observed in routine coagulation tests, suggesting that more sensitive coagulation markers should be evaluated in ICP patients. The high rate of fetal complications indicates that early diagnosis, careful monitoring, and the implementation of individualized management plans are essential for the prevention of hematological and perinatal complications in pregnant women with intrahepatic cholestasis.