Intrahepatic cholestasis of pregnancy: Contemporary management

Abstract

Intrahepatic cholestasis of pregnancy: Contemporary managementIntrahepatic cholestasis of pregnancy (ICP) is the most common liver disorder of pregnancy, occurring in up to 4% of women and varying in frequency according to ethnicity, fetal plurality, mode of conception, and concurrent hepatitis C virus infection. 1 It is characterised by itch and elevated serum bile acids. The association with adverse perinatal outcomes, particularly stillbirth, has previously led to a range of fetal surveillance strategies and interventions, not generally based on robust evidence, and often with adverse unintended consequences such as iatrogenic preterm birth. This issue of ANZJOG features a policy statement by Hague et al on behalf of the Society of Obstetric Medicine of Australia and New Zealand (SOMANZ) presenting the consensus guidelines for the diagnosis and management of ICP. 2 This document is an excellent resource for Australian and New Zealand maternity care providers and should become the standard reference for those who diagnose and treat ICP. The full guideline is available on the SOMANZ website at https://www.somanz.org/content/uploads/2023/08/ SOMANZ-ICP-Consensus-Statement-1.6.23-Web-Version.pdf. ADVERSE MATERNAL OUTCOMESElevated transaminases are observed in around 80% of cases of ICP, although this generally resolves rapidly postpartum along with the ICP. 1 Fat malabsorption can lead to vitamin K deficiency with coagulopathy and bleeding complications, although this is rare and limited to severe cases. [3][4][5] The severe itch that some women experience may have significant negative psychosocial consequences. 6 Intrahepatic cholestasis of pregnancy: Contemporary management