Internal Medicine

0521779407-C01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53

308 Cholestasis of Pregnancy

Cholestasis of Pregnancy...............................

CAROLINE A. RIELY, MD

history & physical

History

■Itching, typically worse at night, on palms and soles, beginning in

the third, or late second, trimester

■May have+family history, or itching with previous pregnancies

Signs and Symptoms

■Excoriations. Pruritus may vary, but doesn’t resolve until delivery

■Jaundice very rarely

tests

Laboratory

■Elevated AST, ALT, may be > 1,000

■Elevated bile acids

■Normal GGTP, alk phosphatase only modestly abnormal

■Hyperbilirubinemia rarely

Liver Biopsy

■Bland cholestasis. Biopsy usually not indicated, diagnosis based on

clinical grounds

differential diagnosis

■Viral hepatitis (+serologies, risk factors)

■Cholestasis due to drugs, other liver diseases (PBC, PSC)

management

What to Do First

■Reassure

General Measures

■Associated with an increased risk of prematurity/still birth

■Consider early delivery, by 38 weeks, or in very severe cases, at 36

weeks if fetal lung mature

specific therapy

■Consider treatment with ursodeoxycholic acid, 15 mg/kg/day in

divided dose. Sedative antipuritics may help (eg hydroxyzine)