The biochemical diagnosis of intrahepatic cholestasis of pregnancy

Abstract

Background Bile acid levels and liver function tests may be normal at presentation in women with intrahepatic cholestasis of pregnancy. The biochemical results of patients presenting with pruritus typical for intrahepatic cholestasis of pregnancy were reviewed. Methods A retrospective audit of women coded as having intrahepatic cholestasis of pregnancy over a three-year period. Results One hundred and ninety-three women (1.1% of the obstetric population) presented with pruritus typical of intrahepatic cholestasis of pregnancy. Forty (21%) of these women had normal biochemistry at presentation, half subsequently developing abnormal results. Women with a history of allergic reactions were more likely to develop intrahepatic cholestasis of pregnancy. Conclusions Normal biochemistry should not preclude a trial of ursodeoxycholic acid in women with distressing pruritus typical for intrahepatic cholestasis of pregnancy. Biochemical tests which are more sensitive and specific in the diagnosis of intrahepatic cholestasis of pregnancy would be valuable. Investigation of other populations with intrahepatic cholestasis of pregnancy regarding a possible association with atopy/allergy would be interesting.

The Recurrent Liver Disorder of a Pregnant Mother: Intrahepatic Cholestasis of Pregnancy – A Case Report and Literature Review

“…The measurement of bile acid concentration is a basic test aimed at diagnosis and therapy monitoring of the ICP. Meanwhile, the activity of alcohol dehydrogenase (ADH) isoenzymes could be considered as having a positive interaction in the sera of women with intrahepatic cholestasis 14 and having a history of allergic reactions may mean they are more likely to develop ICP 15 but for our patient there was no history of allergic reactions. Hence it is better to consider such a test while suspecting and detecting this case.…”

The Determination of Bile Acids in Women Upon Suspicion of Intrahepatic Cholestasis of Pregnancy

“…ICP is a reverse form of cholestasis occurring in pregnancy with symptoms of dysfunction of liver [2]. It is the most common primary liver disorder in pregnant women, affecting about 0.5-1% of pregnancies [3][4][5] and associated with numerous adverse perinatal outcomes [6]. The fetus is threatened by arrhythmia or cardiac arrest and is endangered by the aspiration of meconium-stained amniotic fluid.…”

“…Endocrine factors are involved as well because of increased serum levels of sulphonated Global Journal of Reproductive Medicine progesterone metabolites found in women with ICP mainly in the third trimester and are linked to disease severity [13]. Also, women with a history of allergic reactions were more likely to develop intrahepatic cholestasis of pregnancy [4]. Populationbased studies have highlighted environmental factors contributing to the disease, including reduced dietary selenium, low vitamin D and winter months [3,13].…”

Лабораторная Диагностика Патологии Печени У беременных

“…Это состояние беременной должно прекратиться после родов, но, если лабораторные показатели холестаза (желчные кислоты, ГГТП, ЩФ, холестерин, триглицериды), цитолиза (АлАТ, АсАТ, особенно при НАСГ) остаются повышенными после рождения ребенка, необходимо провести комплексное обследование женщины для исключения первичного билиарного холангита, АИГ и первичного склерозирующего холангита. В этих случаях ВХБ следует расценивать как дебют прогрессирующей хронической патологии печени [52][53][54][55].…”