Intrahepatic Cholestasis of Pregnancy Treatment & Management

Updated: Jan 14, 2019
  • Author: Fidelma B Rigby, MD; Chief Editor: Ronald M Ramus, MD  more...
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Treatment

Medical Care

Antenatal testing, including umbilical artery Doppler studies, biophysical profile (BPP), and nonstress tests, have all been performed to reduce the risk of stillbirth. [53, 54, 55] One study demonstrated that increased fetal testing and scheduled induction with documentation of fetal lung maturity in patients with ICP lessened perinatal mortality rates compared with patients who were not tested. [56]  Another study concluded that bile acids above 100 μmol/L were associated with increased mortality despite twice-weekly antenatal testing. [57] A study by Kohari et al examined the effectiveness of an intensive surveillance system for women with total bile acids >40 μmol/L at < 36 weeks. The intensive surveillance included inpatient admission and continuous FHR monitoring with delivery between 36 and 37 weeks. The authors noted a significant reduction in the stillbirth rate with this intensive surveillance strategy. [58]

Delivery is commonly recommended at 37 weeks’ without an amniocentesis for fetal lung maturity due to increased risk of fetal mortality, or after an amniocentesis for delivery prior to 37 weeks’ gestation. If meconium is present at the time of amniocentesis, delivery is indicated regardless of the fetal lung maturity results. Delivery can proceed without an amniocentesis if the fetal monitoring is nonreassuring. Some providers are now waiting until 38-39 weeks gestation to deliver if there is resolution of pruritus symptoms with treatment and bile acid levels are not significantly elevated (less than 40 micromol/L). 

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Complications

A retrospective case-control study by Furrer et al found no differences in postpartum blood loss in women with intrahepatic cholestasis of pregnancy treated with ursodeoxycholic acid and with a planned delivery at 38 weeks of gestation. [59]

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