Těhotenská cholestáza

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SUMMARY AND RECOMMENDATIONS

●Intrahepatic cholestasis of pregnancy (ICP) occurs in the second and third trimester and is characterized by pruritus and an elevation in serum bile acid concentrations. The onset of ICP is typically heralded by the development of pruritus, which may be intolerable. It is often generalized but predominates on the palms and the soles of the feet and is worse at night. (See 'Clinical manifestations' above.)

●The diagnosis of ICP is based upon the presence of pruritus associated with elevated levels of serum bile acids and/or aminotransferases, and the absence of diseases that may produce similar symptoms. (See 'Diagnosis' above.)

●ICP carries an increased risk of fetal complications. The most concerning complication is the increased risk for sudden fetal death. Although pruritus is bothersome, the maternal prognosis in ICP is good. (See 'Clinical manifestations' above and 'Fetal follow-up and outcome' above.)

●Treatment for ICP focuses on reducing pruritus and preventing maternal and fetal complications. We suggest treatment with ursodeoxycholic acid (ursodiol or UDCA, a synthetic bile acid) (Grade 2B). The optimal dose has yet to be determined; we usually prescribe 300 mg three times a day (or 15 mg/kg per day) until delivery. (See 'Treatment' above.)

●For most women diagnosed with ICP, we suggest delivery at 36 weeks of gestation (Grade 2B). If ICP is diagnosed at ≥37, we initiate delivery upon diagnosis. (See 'Timing of delivery' above.)

●Liver function and bile acid concentration levels should be checked six to eight weeks after delivery. The patient should be referred to a liver specialist to assess for underlying hepatobiliary diseases if these do not return to normal. Affected women may be at increased risk for the development of gallstones. (See 'Maternal follow-up and outcome' above.)

●Cholestasis recurs during subsequent pregnancies in 60 to 70 percent of patients. Recurrent episodes are variable in severity. (See 'Maternal follow-up and outcome' above.)

●ICP is not a contraindication for breastfeeding. (See 'Maternal follow-up and outcome' above.)