Intrahepatic Cholestasis of Pregnancy: A Comparative Review of Guidelines

Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disorder associated with significant maternal complications and increased neonatal morbidity and mortality.

The aim of this study was to review and compare the most recently published influential guidelines on the diagnosis and management of ICP, highlighting the discrepancies in key areas.

A descriptive review of 6 national guidelines from the Society for Maternal-Fetal Medicine, the Royal College of Obstetricians and Gynecologists, the Society of Obstetricians and Gynecologists of Canada, the Society of Obstetric Medicine of Australia and New Zealand, the Chinese Medical Association, and the Working Group on Obstetrics and Prenatal Medicine of Germany was conducted along with a comparison of their recommendations regarding this pregnancy complication.

There is an overall agreement among the reviewed guidelines regarding the definition and the diagnosis of ICP, although minor discrepancies exist with regard to the bile acid cutoff levels. They also highlight the importance of a detailed history and physical examination to exclude other potential causes of maternal pruritus and recommend the evaluation of liver function and the appropriate counseling on the associated maternal and neonatal complications following diagnosis. Ursodeoxycholic acid is recommended by all guidelines (except from the Royal College of Obstetricians and Gynecologists) as first-line treatment for symptoms relief. However, the recommendations regarding the classification of ICP, the frequency of bile acid monitoring, the necessity of fetal surveillance, and the optimal timing of delivery are inconsistent.

Obstetrics cholestasis is a severely pruritic form of reversible cholestasis of unknown pathophysiology that is associated with significant fetal risks and no definitive treatment. The variations among the existing guidelines reflect the heterogeneity of available evidence, while highlighting the necessity for further research.

Obstetricians and gynecologists, family physicians.

After participating in this activity, the learner should be better able to explain the process of differential diagnosis when ICP is suspected; identify the ICP-associated fetal and maternal risks on which affected individuals should be counseled; and describe the medical treatment options and the optimal timing of delivery.