Intrahepatic cholestasis of pregnancy: case report

Abstract

Objective: to report the pregnancy outcome of a patient with intrahepatic cholestasis treated at a public service in northern Brazil. Case Report: primiparous, 24 years old, mixed race, gestational age of 29 weeks, referred intense body pruritus, predominantly palmoplantar, anxiety and pelvic pain. She denied nausea and vomiting, vaginal discharge, other illnesses, surgeries and allergies. On clinical examination, there was no hepatomegaly or jaundice. Laboratory tests showed increased concentration of bile acid levels 43μmol/L, liver enzymes alanine transaminase 1,382U/L, aspartate aminotransferase 752U/L, lactate dehydrogenase 718U/L, gamma glutamyl transferase 43U/L and alkaline phosphatase 196U/L. She was diagnosed with intrahepatic cholestasis of pregnancy and medicated with 900 mg of ursodeoxycholic acid daily, divided into three doses; pain relievers; antihistamines; cephalexin 500mg and nitrofurantoin 100mg. At 31 weeks and three days of pregnancy, body itching, anxiety and pelvic pain were stronger and laboratory tests maintained the elevation of liver enzymes, with emphasis on alanine transaminase 1,962 U/L. It was decided to interrupt the pregnancy with an elective cesarean section, waiting for eight hours of fasting, in addition to the start of corticosteroids for fetal lung maturation. Five days after delivery, there was clinical improvement and reduction in the values of liver function tests. Conclusion: despite the positive outcome for the mother, premature birth resulted in the death of the newborn after a few days in the neonatal intensive care unit.

Keywords

• intrahepatic cholestasis
• pregnancy
• high-risk
• pregnancy complications
• case report