Abstract
Intrahepatic cholestasis of pregnancy (ICP) is a gestation-specific liver disorder, defined most often as the onset of pruritus, usually from the third trimester of pregnancy, associated with abnormal liver test results and/or increased total serum bile acids and spontaneous relief after delivery. The 21-year-old patient was admitted to our ward in the 11th week of pregnancy due to raised liver enzymes. The first onset of pruritus and jaundice appeared a month before hospitalization. Immunology tests and Toxoplasma gondii were negative. We excluded viral etiology, while alpha-1-antitrypsin, serum and urine copper levels, and thyroid hormones were within the reference values. The patient denied she had taken any medicines and herbal preparations before and during pregnancy. Total bile acids in the serum were significantly elevated (242 μmol/L). The abdominal ultrasound revealed a regular finding. Liver biopsy suggested a cholestatic liver disorder. After a presentation of all risks, the patient decided to stop the pregnancy. After a month, the hepatogram was within the reference values. Very rarely an ICP can occur in early pregnancy (first trimester), which calls for close monitoring. The risk of serious adverse fetal outcomes and spontaneous preterm delivery is proportional with increased levels of maternal serum bile acid.
Highlights
Intrahepatic cholestasis of pregnancy (ICP) was firstly described in 1883 [1]
ICP is the first cause of jaundice in pregnancy after exclusion of viral hepatitis [3]
Most often the disease affects women in the third trimester of pregnancy with a history of intrahepatic cholestasis during previous pregnancies [7], history of cholestasis related to the use of oral contraceptives [16], family or personal history of biliary disease [17], hepatitis C viral infection [18], twin pregnancies [19], or in vitro fertilization pregnancies [20]
Summary
Intrahepatic cholestasis of pregnancy (ICP) was firstly described in 1883 [1]. It is a gestation-specific liver disorder, defined most often as onset of pruritus, usually in the third trimester of pregnancy. ICP is the first cause of jaundice in pregnancy after exclusion of viral hepatitis [3]. The prevalence of this liver disorder varies according to geographical location and ethnicity, as genetic and environmental factors are recognized to be a part of its manifestation [4]. Hepatobiliary diseases were more often confirmed in women with ICP (hazard ratio (HR) 2.62), hepatitis C or chronic hepatitis (HR 4.16 and 5.96, respectively), fibrosis/cirrhosis (HR 5.11), gallstone disease or cholangitis (HR 2.72 and 4.22, respectively) as compared to women without ICP (p < 0.001 for all HRs) [15]
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