Prolonged postpartum course of intrahepatic cholestasis of pregnancy

Cholestatic jaundice of pregnancy is generally a self-limiting condition that occurs in the last trimester and disappears within 1-2 weeks after delivery. The cases of two women who developed severe intrahepatic cholestasis of pregnancy are presented. After delivery, pruritus and jaundice increased and the maximal level of bilirubin reached 500 and 433 mumol/L, respectively (normal, < 20 mumol/L). A familial aggregation was present in one case. Extensive laboratory, radiological, and histopathological investigation showed no other cause of jaundice. Cholestyramine, ursodeoxycholic acid, S-adenosylmethionine, evening primrose oil, and ultraviolet light were used without evidence of efficacy. On the other hand, after corticosteroids were given pruritus ceased and biochemical alterations became normal 35 and 43 weeks, respectively, after delivery. During follow-up 2 years after delivery in one patient, symptoms have not recurred and liver function tests have remained normal. A therapy-resistant dry cough in the other patient is described as a new clinical symptom of severe cholestasis.