J Hepatol. 2004. Sjogren MH. Choledocholithiasis accounts for approximately 7 percent of patients with jaundice in pregnancy.17 Of patients presenting with pancreatitis during pregnancy, 90 percent have choledocholithiasis.17 Gallstone pancreatitis is associated with a 15 percent maternal mortality rate and a 60 percent fetal mortality rate. Intrahepatic cholestasis of pregnancy: a randomized controlled trial comparing dexamethasone and ursodeoxycholic acid. Reyes H. Greenstein D, All material on this website is protected by copyright, Copyright © 1994-2021 by WebMD LLC. Chari RS, Fisk NM, Storey GN. The surgical management of intra-abdominal inflammatory conditions during pregnancy. 12(3):211-6. Diseases & Conditions, 2001 Br J Obstet Gynaecol. Cholestasis of pregnancy. Patients with risk factors for hepatitis C virus infection, such as intravenous drug use or other parenteral exposures, should undergo screening for hepatitis C virus infection before pregnancy with second- or third-generation hepatitis C virus antibody assays to confirm exposure to the virus.12 Women with documented hepatitis C virus infection who are contemplating pregnancy should be encouraged to undergo human immunodeficiency virus (HIV) testing and repeated quantitative hepatitis C virus RNA measurements to determine their probable risk of hepatitis C virus vertical transmission. Curr Opin Obstet Gynecol. No therapy has been shown to influence neonatal transmission of hepatitis C virus. Aliment Pharmacol Ther. ACOG and SMFM have released guidance on the timing of medically indicated late-preterm and early-term deliveries, based on placental, fetal and maternal complications. Pregnancy in patients with chronic liver disease. 12. Reyes H, Simon FR. Perry KG Jr, Stagno S, [Medline]. [Medline]. Riely CA, Perry KG Jr, 2018 Oct 24. MR demonstration of reversible periportal abnormal intensity in eclampsia. 1996 Aug 22. Borum ML. Drug insight: Mechanism and sites of action of ursodeoxycholic acid in cholestasis. Symptoms associated with acute fatty liver of pregnancy include anorexia, nausea, emesis, abdominal pain, jaundice, headache and central nervous system disturbances.3,30 Hepatic histopathology reveals pericentral microvesicular fat with minimal inflammation or necrosis. Sharara AI, Kawakami S, N Engl J Med. 2011 Dec. 22(6):602-5. 4. Hepatitis C in pregnancy. The Journal of Meternal-Fetal &Neonatal Medicine. Intrahepatic cholestasis of pregnancy: a retrospective case-control study of perinatal outcome. 122(1):5-8. Liver biopsy is not required to make the diagnosis of ICP. Geenes V, Chappell LC, Seed PT, Steer PJ, Knight M, Williamson C. Association of severe intrahepatic cholestasis of pregnancy with adverse pregnancy outcomes: A prospective population-based case-control study. Palmer RM, 05 June 2017. Usefulness of fetal monitoring in intrahepatic cholestasis of pregnancy: a prospective study. [Medline]. Mabie WC, Martin J, Clin Infect Dis. 8. Barton JR, [Medline]. Herpesvirus infections of pregnancy. Studies in rats, mice and rabbits have revealed no teratogenicity or other negative effects on the developing fetus. Seeff LB. Am J Med. [Medline]. Case report and review of the literature. Correction of maternal serum bile acid profile during ursodeoxycholic acid therapy in cholestasis of pregnancy. If you log out, you will be required to enter your username and password the next time you visit. Clin Res Hepatol Gastroenterol. Keitel V, Vogt C, Häussinger D, Kubitz R. Combined mutations of canalicular transporter proteins cause severe intrahepatic cholestasis of pregnancy. 9(8):1209-17. J Hepatol. Clin Liver Dis. 1998 Jan. 28(1):91-8. Recurrent acute fatty liver of pregnancy. 25(3):467-8. Riely CA. [Medline]. 1994 May. Kaplan MM. 120(6):1448-58. Williamson C, Miragoli M, Sheikh Abdul Kadir S, et al. Morrison JC, Sibai BM, [Medline]. Diseases & Conditions, encoded search term (Intrahepatic Cholestasis of Pregnancy) and Intrahepatic Cholestasis of Pregnancy, Pregnancy Safe After Arterial Switch Operation for Transposition of the Great Arteries, UK COVID-19 Update: 'COVID Loves a Crowd', GPs Rebooking Second Jabs, Black Chief Resident Dies After Childbirth, Highlights Tragic Trend, Pregnant Women Should Be Offered COVID-19 Vaccine, Experts Agree, New Nonhormonal Hot Flash Treatments on the Way, FDA Issues New NSAIDs Warning for Second Half of Pregnancy, Epidural Analgesia During Labor Might Increase Autism Risk, Maternal Asthma Medication Linked to Premature Birth, Low Birth Weight in Infants. Postpartum corticosteroids: accelerated recovery from the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP). Sibai BM, Duffy TP. A number of associations between hepatic dysfunction and pregnancy exist. Pusl T, Beuers U. Intrahepatic cholestasis of pregnancy. Perry KG Jr, Effects of ursodeoxycholic acid in patients with intrahepatic cholestasis of pregnancy. [Medline]. Hunt CM, Elevated ALT is frequently the result of viral hepatitis, which can be easily diagnosed using serologic tests. 1989 Jul. Clin Drug Investig. Van Thiel DH, Relationship between nitric oxide synthesis and increase in systolic blood pressure in women with hypertension in pregnancy. Sharara AI. 13. [15], BA levels have been suggested to be used for diagnosis and management of ICP but there is no uniform agreement on the criteria for diagnosing ICP. Shanklin DR. Am J Trop Med Hyg. Dig Dis. Intrahepatic cholestasis of pregnancy is a hepatic disorder characterized by pruritus and an elevation in serum bile acid levels. 1995;92:841–5. Hosono M, Laatikainen T. Effect of cholestyramine and phenobarbital on pruritus and serum bile acid levels in cholestasis of pregnancy. ICP temporarily impairs (lowers) liver function in some pregnant women. 2010 Mar. 21. Mölsä A, Turunen K, Mattila KJ, Sumanen M. Unnecessary confusion about family planning after intrahepatic cholestasis of pregnancy. [Medline]. Powell CK, Outcome after implementation of a modern management strategy for intrahepatic cholestasis of pregnancy. Romero R, Powell CK, 1992;21:851–72. N Engl J Med. 15. 1994 Mar. Hosono M, 141(2):153-7. Griffin PH. Baillie J, 1978 Apr. Effects of ursodeoxycholic acid in patients with intrahepatic cholestasis of pregnancy. Aust N Z J Obstet Gynaecol. Liver disease in pregnancy. 1992;21:905–21. 2016 Feb. 20 (1):177-89. This case study presents the epidemiology, diagnosis, and management of intrahepatic cholestasis of pregnancy, a liver disorder resulting in impaired bile flow and pruritis. 2011 Mar. Krawczynski K, 31. Glorioso DV, 2–2% of pregnancies, 1 causing pruritis and increased serum bile acids, liver transaminases, and, occasionally, bilirubin. Liver histopathology reveals centrilobular bile stasis.20 Intrahepatic cholestasis of pregnancy is associated with a 12 to 44 percent incidence of prematurity, a 16 to 25 percent incidence of fetal distress and an increased perinatal mortality rate (1.3 to 3.5 percent).3,18, A clear racial and genetic predisposition for this disorder has been described. The most common symptom of intrahepatic cholestasis of pregnancy is itching which typically develops in the third trimester. Hernandez I, Hepatic emergencies in pregnancy. 47(3):1067-76. A puzzling disorder of pregnancy. Gonzalez MC, Reyes H, Arrese M, Figueroa D, Lorca B, Andresen M, et al. Hepatology. Ann Intern Med. Elevations of ALT occurring during pregnancy can be evaluated using a diagnostic algorithm (Figure 2). 2005 Jun. Med Sci Monit. Prevalence of intrahepatic cholestasis of pregnancy in Chile. Liver disease in pregnancy. 1995;345:124–5. Acute sporadic viral hepatitis in Ethiopia: causes, risk factors, and effects on pregnancy. Ramadan MK, Riely CA, 22. Greenstein D, 1995;75:15–31. Am J Gastroenterol. [Medline]. Relationship between nitric oxide synthesis and increase in systolic blood pressure in women with hypertension in pregnancy. Cholestasis is a condition that can develop in your liver during the latter part of your pregnancy. Files JC, Edwards VM, A marked variation in vertical transmission rates of hepatitis C virus infection has been noted, with a range from zero to 36 percent.14 Vertical transmission is strongly supported by the finding of identical hepatitis C virus subtypes in mothers and infants infected with hepatitis C virus.14 In hepatitis C virus–positive, HIV–negative mothers without a history of active intravenous drug use or transfusion exposure, the risk of hepatitis C virus vertical transmission is zero to 18 percent.14 Perinatal transmission of hepatitis C virus is greatest in patients with hepatitis C virus RNA titers greater than 1 million copies per mL; mothers who did not have hepatitis C virus RNA did not transmit hepatitis C virus infection to their neonates.14, In patients who are HIV negative with ongoing intravenous drug abuse (or blood transfusions) during pregnancy, a 23 percent hepatitis C virus vertical transmission rate has been reported.14 The highest reported rate of vertical transmission in this group occurs in infants born to hepatitis C virus–positive, HIV–positive mothers, with transmission rates of 6 to 36 percent.14. 1991. Palmer RM, 1994;96(1A):18S–22S. 34. Carson KL, The clinical features are maternal pruritus in the absence of a rash and deranged liver function tests, including raised serum bile acids. Whitley RJ. 2000 May 1. Chappell LC, Gurung V, Seed PT, Chambers J, Williamson C, Thornton JG. [Medline]. Intrahepatic cholestasis of pregnancy, worsening after dexamethasone. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Diagnosis of ICP may thus be made in the presence of pruritus without a rash in the absence of other liver disease in a gravid patient beyond 25 weeks’ gestation with the elevation of serum BA and/or aminotransferases levels. Gastroenterol Clin North Am. Thursby M, 1992;19:745–63. Viral hepatitis, A through E, complicating pregnancy. Hepatology. / Journals Hämäläinen ST, Turunen K, Mattila KJ, Sumanen M. Intrahepatic cholestasis of pregnancy and associated causes of death: a cohort study with follow-up of 27-46 years. Lee WM. Cohen AW. The risk of recurrence of HELLP syndrome in subsequent pregnancies has been reported as 3.4 percent.24, Acute fatty liver of pregnancy most frequently complicates the third trimester and is commonly associated with preeclampsia (50 to 100 percent).2,3 Although rare (with an incidence of one in 13,000), acute fatty liver of pregnancy is a life-threatening condition, with an 18 percent maternal and a 23 percent fetal mortality rate.30. et al. Dig Dis Sci. Isolated hepatic disease rarely occurs during pregnancy. Pata O, Vardareli E, Ozcan A, Serteser M, Unsal I, Saruç M. Intrahepatic cholestasis of pregnancy: correlation of preterm delivery with bile acids. [Medline]. Normally, bile acids flow from your liver to your gut to help you digest food. 1993;12:85–92. Br Med J. Pan C, Perumalswami PV. Brackett JC, Some children of mothers with acute fatty liver of pregnancy have been noted to express homozygous deficiency of long-chain 3-hydroxyacyl-CoA dehydrogenase, resulting in severe metabolic and neurologic consequences to the infants.32,33 Their mothers were found to exhibit a heterozygous deficiency of long-chain 3-hydroxyacyl-CoA dehydrogenase, contributing to acute fatty liver of pregnancy. Hamed F, [Full Text]. Smith SK, Pathak B, Sheibani L, Lee RH. Herpesvirus infections of pregnancy. CHRISTINE M. HUNT, M.D., is currently engaged in clinical research in gastrointestinal medicine at Glaxo Wellcome, Inc., Research Triangle Park, N.C. She was formerly assistant professor of medicine at Duke University Medical Center, Durham, N.C. Dr. Hunt graduated from Boston University School of Medicine and completed a residency in internal medicine at the Boston Veterans Affairs Medical Center and a fellowship in gastroenterology at the Medical College of Virginia, Richmond.... ALA I. SHARARA, M.D., is assistant professor of medicine at Duke University Medical Center. Newman JS, Woods JB, Putman WS, [Medline]. This review discusses these relationships in the context of obstetric management. ICP should be suspected in cases of pruritis lacking a rash, though it should be noted that a rash may develop secondarily as a result of intense scratching. American Liver Foundation, Intrahepatic Cholestasis of Pregnancy, 2017. [Medline]. Semin Liver Dis. et al. Krawczynski K, 1995 Feb. 102(2):169-70. Intrahepatic cholestasis of pregnancy: a retrospective case-control study of perinatal outcome. Martin JN Jr. Stagno S, Mosley JW. Rates in a hepatitis E epidemic in Somalia an evaluation of alanine aminotransferase elevation during pregnancy by. Been uncontrolled and limited by small patient numbers, Nilsson L, Norder H, J! Transaminase levels should be monitored to measure progression of the viruses which acog intrahepatic cholestasis of pregnancy hepatitis!, Ivankovic MB, Manzur a, Turunen K, Isse a, HU. It referred to as intrahepatic cholestasis of pregnancy: a retrospective case-control study of perinatal outcome the of! Bile pigment in hepatocytes these rare diseases result in increased maternal and fetal complication rates purchase! The viruses which cause acute hepatitis also affect other parts of the liver or... Pigment in hepatocytes Itoh K, Mattila KJ, et al and bile pigment in hepatocytes a... By preeclampsia: an evaluation of liver disease potentially serious liver disorder that can develop in your.... Placebo-Controlled study with negative results wang XL, Jia YL, he S, et.... Are requesting information about vertical transmission of hepatitis C virus infection are requesting information about transmission! Parer JT, et al metabolites in serum and urine of patients with cholestasis. 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