[Intrahepatic cholestasis of pregnancy. Maternofetal implications]

To analyze a group of pregnancies complicated by intrahepatic cholestasis in order to favour an early recognition and to decrease maternal and fetal morbid-mortality.

Retrospective study of 46 pregnancies with intrahepatic gravidic cholestasis between 1990-94. We review the most relevant epidemiologic, clinical and biological features and the obstetric and perinatal results. The study group was compared with 1652 non complicated pregnancies (control group) from the same period of time. The statistic evaluation was made with t Student and chi 2.

The incidence was 0.18% (mean age of 27.8 +/- 6.7 years) similar to the control group, and a greater rate of primiparity (p < 0.05) and twin pregnancies (p < 0.001). The most frequent symptom was pruritus, followed by choluria (23.9%) and signs of cutaneous scratching (17.3%). Only 5 patients (10.8%) had jaundice. The GPT was greater than 100 U/1 in 29 cases (63.1%) and the GOT in 17 (37%). In 25 pregnancies (54.3%) the alkaline phosphatase exceeded 600 U/L and 28 (60.8%) had bilirubin normal values. Urinary tract infections (26%) and preterm labor (17.3%) were significantly more frequent (p < 0.001) in patients with intrahepatic cholestasis of pregnancy, as well as induced labor rate and cesarean section percentages (p < 0.001). The neonatal prognosis was significantly worse, with 10 preterm babies, 6 with 5 minutes Apgar score lower than 7, and 3 perinatal deaths. All the patients recovered their normal status after delivery.

In intrahepatic gravidic cholestasis moderate cytolysis, infrequent jaundice and cholestasis can be important. The pregnancies should be considered of high risk, and should be managed aggressively as soon as fetal maturity allows it.