Cholestasis and Pregnancy

Abstract

Obstetric cholestasis is an intrahepatic multifactorial disease, unique to pregnancy which presents with intense pruritis and abnormal liver function tests (LFTs). It commonly presents in the third trimester and becomes more severe with advanced gestation. The prevalence of obstetric cholestasis is influenced by genetic and environmental aspects and varies in different populations. The pathogenesis appears to relate to a predisposition to the cholestatic effect of increased circulating oestrogens and progestogens. Also genetic mutations have been reported in a sub-group of women with elevated γ-GT. There can be significant maternal morbidity due to intense pruritis and consequent sleep deprivation. There may be malabsorption with steatorrhea resulting in vitamin K deficiency, prolongation of clotting times and increased risk of postpartum haemorrhage (PPH). Caesarian section rate is much higher for women with obstetric cholestasis. The potential fetal risks include preterm labour and prematurity and unexplained intrauterine death. The aim of the management of obstetric cholestasis is to avoid fetal complications and to relieve maternal symptoms. A variety of drug therapies have been used to reduce maternal pruritis. Policies of active management and induction of labor before 38 weeks may improve pregnancy outcome. Obstetric cholestasis is a diagnosis of exclusion, and other causes of pruritis should be excluded.