ContentsSynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyReferencesView all Images (2)
Emergency: requires immediate attention
Cholestasis of pregnancy
Print
Other Resources UpToDate PubMed
Emergency: requires immediate attention

Cholestasis of pregnancy

Print Images (2)
Contributors: Mitchell Linder MD, David Brodell MD
Other Resources UpToDate PubMed

Synopsis

Intrahepatic cholestasis of pregnancy (ICP) is a disease where patients develop pruritus and elevated liver function values. The true etiology of this condition is unknown but thought to be multifactorial, including genetic, hormonal, and environmental factors. ICP is more common in patients of Northern European descent and those with ancestry from Chile / South America. Family history is a predisposing factor. Other risk factors include multifetal pregnancy, personal history of the disease, patients receiving assistive reproductive treatments, and patients with advanced maternal age.

This condition occurs in about 1:1000 pregnancies in the United States. Although it may occur in any trimester, patients will usually present in the third trimester with complaints of new-onset itching throughout their body but notably on their hands (palms) and feet (soles). Usually there will be no rash / visible findings at time of examination. Symptoms are often worse at night and can vary in severity from mild to severe. Patients may also complain of right upper quadrant pain, fatigue, a change in the color of their bowel movements, or jaundice.

Bile acids cross the placenta and can build up in the fetus. Risks to the fetus include fetal demise in utero (FDIU), meconium-stained amniotic fluid, preterm delivery, and respiratory distress.

For more information, see OMIM.

Codes

ICD10CM:
O26.619 – Liver and biliary tract disorders in pregnancy, unspecified trimester

SNOMEDCT:
235888006 – Cholestasis of pregnancy

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

  • Polymorphic eruption of pregnancy (PEP) / pruritic urticarial papules and plaques of pregnancy (PUPPP) – usually has itching as a focal factor, but mainly in areas of stretchmarks and with a periumbilical-sparing rash.
  • Acute fatty liver of pregnancy – elevated liver function tests (LFTs), abdominal pain, nausea, and central nervous system abnormalities. Emergency condition that requires immediate action.
  • Gallstones – liver test abnormalities, suggestive imaging, elevated WBC count.
  • Biliary disease (eg, cholecystitis, cholangitis)
  • Liver abscess (eg, amebic, pyogenic)
  • Hepatitis B or hepatitis C
  • Atopic dermatitis
  • Preeclampsia – usually not associated with itching, will have proteinuria and elevated blood pressures.

Best Tests

Subscription Required

Management Pearls

Subscription Required

Therapy

Subscription Required

References

Subscription Required

Last Reviewed: 03/06/2018
Last Updated: 04/19/2018
Copyright © 2018 VisualDx®. All rights reserved.
Emergency: requires immediate attention
Cholestasis of pregnancy
Print 2 Images
View all Images (2)
(with subscription)
Cholestasis of pregnancy : Dark urine, Fatigue, Jaundice, Nausea, Alkaline phosphatase elevated, ALT elevated, AST elevated, Palms and soles, Anorexia, Pruritus without rash, RUQ pain, Pale feces
Copyright © 2018 VisualDx®. All rights reserved.