Intrahepatic Cholestasis of PregnancyO26.60

Generalized pruritus with inconspicuous skin during pregnancy, especially on the palms of the hands and soles of the feet. The itching usually begins in the 3rd trimester and disappears after delivery (Zeidler C et al. 2020).

GPT and bilirubin often elevated; evidence is the increase of bile acid concentration in serum > 10 µmol/l (decrease on fasting!)

Ursodeoxycholic acid 12.5-20 mg/kg bw/d, daily dose approximately 1g (4 tbls), results in reduction of pruritus and fetal risks; close monitoring, early initiation if necessary.

There is a risk of recurrence in subsequent pregnancy and when taking oral contraceptives

With bile acids > 40 µmol/l, there is an increased rate of preterm and stillbirths as well as increased perinatal mortality; fetal prognosis correlates with the severity of the clinical picture

1. Smith DD et al (2020) Intrahepatic Cholestasis of Pregnancy. Clin Obstet Gynecol 63:134-151.
2. Zeidler C et al. (2020) Clinical shortcuts in the differential diagnosis of pruritus. Dermatologist 71: 493-499