Cholestasis gravidarum in women in the second and third trimester of gestation, clinical and specific pharmacological treatment and its benefits. An evidence-based approach

Abstract

Introduction: Cholestasis gravidarum is a syndrome that usually occurs in pregnant women in the second or third trimester of gestation and ends in the puerperium. It is clinically characterized by the presence of predominantly nocturnal pruritus that is initially palmo-plantar and then generalized. With alterations in liver function with or without jaundice and elevated serum bile acid levels, biochemical cholestasis is classified as mild to moderate severity. Objective: Diagnostic methods and pharmacological treatment approaches that provide the best results for these patients. Methods: Systematic review using the terms MESH (cholestasis of pregnancy) that generated 2597 results. Results: 28 papers were analyzed in more detail, of which 12 papers were finally selected for the final analysis. Treatment: Ursodeoxycholic acid (UDCA), a beta epimer of chenodeoxycholic acid, is a bile acid more polar than primary bile acids, with substantial choleretic and other multiple chemoprotective effects. The mechanism of action is not completely understood, but studies have shown that after treatment there is a reduction in total serum bile acids in both maternal and cord serum and a qualitative change in the serum bile acid pool. When compared with all controls, UDCA was also found to be associated with a decrease in the incidence of preterm birth, neonatal respiratory distress, and the number of neonatal admissions to intensive care units. Conclusions: The treatment of cholestasis gravidarum is oral administration of ursodeoxycholic acid is effective and safe in the treatment of patients with cholestasis gravidarum.