[Cholestasis in pregnancy. A pure cytolytic form]

Intrahepatic cholestatic disease in pregnancy is the second most frequent cause of jaundice after viral hepatitis. Elevated serum alkaline phosphatase is always found but is of little aid for diagnosis.

A 32-year-old woman (third gestation, second parturition) consulted at 31 weeks gestation after progressive development of pruritus then jaundice. Transaminase levels were elevated. The diagnosis of intrahepatic cholestasis was retained despite normal alkaline phosphatase levels throughout the disease course.

Intrahepatic cholestasis of pregnancy is rare in France compared with its frequency in Latin America and in Scandinavia. The pathogenesis remains uncertain. Diagnosis is based on clinical and laboratory findings as well as morphological arguments. Nevertheless, the results of liver tests vary widely. Transaminase levels may rise greatly but no prior case with normal alkaline phosphatase levels has been reported. Most importantly, clinical course is spontaneously regressive; pruritus and jaundice disappear within a few days after delivery allowing the diagnosis of intrahepatic cholestasis of pregnancy.