Intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis takes the second place among the causes of icterus in pregnancy. The disease incidence is 0, 2-1%. The etiology and pathogenesis is not clear. But it is supposed to be involved with genetic predisposition to an abnormal reaction to an increased estrogen level in pregnancy.  As excess amount of estrogen level stimulates bile production and decreases bile excretion, due to this process a large amount of stimulated bile is back to a host s blood. Especially conjugated bile level increases. This idea is confirmed due to the fact that the disease is manifested in the 2nd and 3rd trimesters when the estrogen level is the highest. The disease is manifested only in pregnancy.

Intrahepatic cholestasis of pregnancy is manifested with an agonizing itch and icterus. The itch can be revealed 1-2 weeks before the icterus develops. Some scientists involve the itch in the last trimester of pregnancy with the subclinical course of disease. Complaints such as vomitus, nausea, mild pain in the upper right side can be present.

What happens to the liver?

Liver biopsy shows neither inflammation nor necrosis.  Enlargement of biliary ductless because if biliary thrombus and biliary sedimentation in the adjacent hepatocytes are revealed.

Liver and spleen size do not change.

High level of bilirubin (3-5 times), bile acids alkaline phosphatase, gamma glutamyl transpeptidase, 5-nucleotidase , cholesterol, triglycerides is determined in blood. ALT and AST level are not increased.

Clotting factors especially protrombine decreases.

The disease must be differentiated with virus hepatitis, cholelitiasis and primary biliary cirrhosis.

It is easy to diagnose the intrahepatic cholestasis of pregnancy in repeated pregnancies.

The treatment of the disease is symptomatic.  The medicines for bile acid bonding must be prescribed for 1-2 weeks. And we must keep it in mind that such type of medicines disturbs vitamin A, D, E, K absorption. That is why these vitamins must be prescribed parenteral.  Besides it xylite and sorbite can be prescribed as choleretics.  Not absorbable antacids can be prescribed for 2-3 weeks too. But prescription of antihistamines is not recommended.

The disease symptoms recover after the birth (in 2-3 weeks). And the disease is not so dangerous because no changes remain after the recovery.

No changes are determined in the liver US after the birth.

The clinical course is usually benign. But there is a high risk of premature birth, prenatal death and postpartum bleeding.

Even if the clinical coure of the disease is not so dangerous the pregnant woman and fetus must be under a clinical observation. Blood clotting factors must be checked regularly.


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