Display options
Share it on

Gynakologe. 2021 Apr 20;1-16. doi: 10.1007/s00129-021-04787-4. Epub 2021 Apr 20.

[Intrahepatic cholestasis of pregnancy].

Der Gynakologe

[Article in German]
Carsten Hagenbeck, Ulrich Pecks, Frank Lammert, Matthi As C Hütten, Felix Borgmeier, Tanja Fehm, Ekkehard Schleußner, Holger Maul, Sven Kehl, Amr Hamza, Verena Keitel

Affiliations

  1. Klinik für Frauenheilkunde und Geburtshilfe, Universität Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Deutschland.
  2. Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland.
  3. Klinik für Innere Medizin II, Universitätsklinikum des Saarlandes, Universität des Saarlandes, Homburg, Deutschland.
  4. Neonatologie, Maastricht Universitair Medisch Centrum+, Maastricht, Niederlande.
  5. Klinik für Geburtsmedizin, Universität Jena, Jena, Deutschland.
  6. Frauenklinik, Asklepios Kliniken Barmbek, Wandsbek und Nord-Heidberg, Hamburg, Deutschland.
  7. Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland.
  8. Kantonsspital Baden, Baden, Schweiz.
  9. Klinikum für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universität des Saarlandes, Homburg, Deutschland.
  10. Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universität Düsseldorf, Düsseldorf, Deutschland.

PMID: 33896963 PMCID: PMC8056200 DOI: 10.1007/s00129-021-04787-4

Abstract

Intrahepatic cholestasis of pregnancy (ICP) is the most frequent pregnancy-specific liver disease. It is characterized by pruritus and an accompanying elevation of serum bile acid concentrations and/or alanine aminotransferase (ALT), which are the key parameters in the diagnosis. Despite good maternal prognosis, elevated bile acid concentration in maternal blood is an influencing factor to advers fetal outcome. The ICP is associated with increased rates of preterm birth, neonatal unit admission and stillbirth. This is the result of acute fetal asphyxia as opposed to a chronic uteroplacental insufficiency. Reliable monitoring or predictive tools (e.g. cardiotocography (CTG) or ultrasound) that help to prevent advers events are yet to be explored. Medicinal treatment with ursodeoxycholic acid (UDCA) does not demonstrably reduce adverse perinatal outcomes but does improve pruritus and liver function test results. Bile acid concentrations and gestational age should be used as indications to determine delivery. There is a high risk of recurrence in subsequent pregnancies.

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2021.

Keywords: Bile acids and salts; Liver diseases; Pruritus; Stillbirth; Ursodeoxycholic acid

References

  1. Am J Physiol Gastrointest Liver Physiol. 2017 Jul 1;313(1):G1-G6 - PubMed
  2. Lancet. 1999 Jan 16;353(9148):210-1 - PubMed
  3. J Med Genet. 2003 May;40(5):e70 - PubMed
  4. Acta Obstet Gynecol Scand. 1986;65(1):23-6 - PubMed
  5. Lancet Glob Health. 2016 Feb;4(2):e98-e108 - PubMed
  6. Obstet Med. 2011 Jun;4(2):66-9 - PubMed
  7. Clin Sci (Lond). 2001 Apr;100(4):363-9 - PubMed
  8. Cochrane Database Syst Rev. 2013 Jun 24;(6):CD000493 - PubMed
  9. BMJ. 2012 Jun 13;344:e3799 - PubMed
  10. Lancet. 2019 Mar 2;393(10174):899-909 - PubMed
  11. Gastroenterology. 1981 Jan;80(1):154-8 - PubMed
  12. Geburtshilfe Frauenheilkd. 2016 Jul;76(7):799-808 - PubMed
  13. Cochrane Database Syst Rev. 2020 Jul 27;7:CD000493 - PubMed
  14. Medicine (Baltimore). 2016 Oct;95(40):e4949 - PubMed
  15. Hepatology. 2006 Apr;43(4):723-8 - PubMed
  16. PLoS One. 2014 Jan 08;9(1):e83828 - PubMed
  17. Hepatology. 1983 Jan-Feb;3(1):12-7 - PubMed
  18. Pediatrics. 2006 May;117(5):1669-72 - PubMed
  19. AJP Rep. 2016 Mar;6(1):e38-41 - PubMed
  20. Clin Liver Dis (Hoboken). 2014 Sep 26;4(3):58-61 - PubMed
  21. J Matern Fetal Neonatal Med. 2020 Jan 19;:1-11 - PubMed
  22. Am J Clin Pathol. 1980 Feb;73(2):196-201 - PubMed
  23. Dig Dis. 2011;29(1):58-61 - PubMed
  24. BJOG. 2012 Mar;119(4):493-8 - PubMed
  25. Eur J Obstet Gynecol Reprod Biol. 2015 Jun;189:59-63 - PubMed
  26. Acta Obstet Gynecol Scand. 1986;65(2):107-13 - PubMed
  27. Clin Res Hepatol Gastroenterol. 2017 Feb;41(1):39-45 - PubMed
  28. N Engl J Med. 1981 Feb 5;304(6):359 - PubMed
  29. Hepatology. 2013 Oct;58(4):1385-91 - PubMed
  30. Clin Liver Dis. 2016 Feb;20(1):177-89 - PubMed
  31. Z Gastroenterol. 2015 Dec;53(12):1436-46 - PubMed
  32. Am J Gastroenterol. 2010 Mar;105(3):585-95 - PubMed
  33. Am J Obstet Gynecol. 2021 Feb;224(2):B2-B9 - PubMed
  34. BJOG. 2011 Nov;118(12):1446-54 - PubMed
  35. Gastroenterol Clin North Am. 1992 Dec;21(4):905-21 - PubMed
  36. Br J Obstet Gynaecol. 1998 Nov;105(11):1205-7 - PubMed
  37. J Gastroenterol Hepatol. 1997 Mar;12(3):211-6 - PubMed
  38. Lancet. 2019 Sep 7;394(10201):849-860 - PubMed
  39. Nat Genet. 2015 May;47(5):435-44 - PubMed
  40. BJOG. 2004 Jan;111(1):17-21 - PubMed
  41. Biochim Biophys Acta Mol Basis Dis. 2018 Apr;1864(4 Pt B):1345-1355 - PubMed
  42. Am J Obstet Gynecol. 2015 Sep;213(3):395.e1-8 - PubMed
  43. J Hepatol. 2009 Aug;51(2):237-67 - PubMed
  44. Eur J Obstet Gynecol Reprod Biol. 1991 Dec 13;42(3):211-5 - PubMed
  45. Medicine (Baltimore). 2020 Jul 31;99(31):e21416 - PubMed
  46. Ann Intern Med. 1978 Apr;88(4):487-93 - PubMed
  47. J Hepatol. 2015 Apr;62(4):897-904 - PubMed
  48. Gastroenterology. 2003 Apr;124(4):1037-42 - PubMed
  49. Am J Obstet Gynecol. 2014 Sep;211(3):189-96 - PubMed
  50. Am J Obstet Gynecol. 2003 Aug;189(2):577-82 - PubMed
  51. Placenta. 2014 Jan;35(1):37-43 - PubMed
  52. J Matern Fetal Neonatal Med. 2015;28(18):2239-43 - PubMed
  53. Am J Gastroenterol. 2016 Feb;111(2):176-94; quiz 196 - PubMed
  54. Clin Obstet Gynecol. 2020 Mar;63(1):134-151 - PubMed
  55. Eur J Obstet Gynecol Reprod Biol. 2019 Sep;240:109-112 - PubMed
  56. Gastroenterology. 2006 Aug;131(2):624-9 - PubMed
  57. Gastroenterology. 2012 Dec;143(6):1492-501 - PubMed
  58. BJOG. 2021 May;128(6):1076 - PubMed
  59. Clin Res Hepatol Gastroenterol. 2016 Apr;40(2):141-53 - PubMed
  60. Placenta. 2012 Nov;33(11):914-8 - PubMed
  61. Heart. 2013 Nov;99(22):1629-30 - PubMed
  62. Br Med J (Clin Res Ed). 1987 Jan 17;294(6565):150-2 - PubMed
  63. J Med Genet. 2009 Oct;46(10):711-5 - PubMed
  64. Hepatology. 2016 Apr;63(4):1287-98 - PubMed
  65. J Hepatol. 2020 Mar;72(3):587-588 - PubMed
  66. Hepatology. 2005 Dec;42(6):1399-405 - PubMed
  67. Eur J Obstet Gynecol Reprod Biol. 2014 May;176:80-5 - PubMed
  68. Ginekol Pol. 2019;90(8):458-463 - PubMed
  69. PLoS One. 2017 Sep 21;12(9):e0183167 - PubMed
  70. J Hepatol. 2000 Dec;33(6):1012-21 - PubMed
  71. Reprod Sci. 2016 Apr;23(4):475-81 - PubMed
  72. Geburtshilfe Frauenheilkd. 2020 May;80(5):499-507 - PubMed
  73. J Obstet Gynaecol. 2017 Jul;37(5):547-549 - PubMed
  74. Eur J Obstet Gynecol Reprod Biol. 2018 Dec;231:180-187 - PubMed
  75. Gastroenterology. 1977 Nov;73(5):1125-30 - PubMed
  76. Hum Mol Genet. 2000 May 1;9(8):1209-17 - PubMed
  77. Pathol Biol (Paris). 1999 Nov;47(9):958-65 - PubMed
  78. Br J Obstet Gynaecol. 1995 Feb;102(2):169-70 - PubMed
  79. Z Gastroenterol. 2016 Dec;54(12):1327-1333 - PubMed
  80. Hypertens Pregnancy. 2020 Aug;39(3):354-360 - PubMed
  81. Acta Obstet Gynecol Scand. 2010 Nov;89(11):1420-3 - PubMed
  82. Eur Rev Med Pharmacol Sci. 2015 Oct;19(19):3770-6 - PubMed
  83. Hum Reprod. 2002 Nov;17(11):2897-903 - PubMed
  84. Ultrasound Obstet Gynecol. 2015 Nov;46(5):571-8 - PubMed
  85. J Matern Fetal Neonatal Med. 2017 Apr;30(8):911-916 - PubMed
  86. Gut. 2007 Feb;56(2):265-70 - PubMed
  87. Heart. 2013 Nov;99(22):1685-92 - PubMed
  88. World J Gastroenterol. 2009 May 7;15(17):2049-66 - PubMed
  89. Sex Reprod Healthc. 2013 Mar;4(1):17-22 - PubMed
  90. Br J Obstet Gynaecol. 1981 Mar;88(3):240-5 - PubMed
  91. Hepatology. 2014 Apr;59(4):1482-91 - PubMed
  92. Obstet Gynecol. 2018 Sep;132(3):678-681 - PubMed
  93. Crit Care Med. 1990 Jan;18(1):77-83 - PubMed
  94. PDA J Pharm Sci Technol. 2020 Mar-Apr;74(2):171-184 - PubMed
  95. AJP Rep. 2015 Oct;5(2):e168-71 - PubMed
  96. Chin Med J (Engl). 1986 Dec;99(12):957-60 - PubMed
  97. BJOG. 2004 Aug;111(8):867-70 - PubMed
  98. Eur J Obstet Gynecol Reprod Biol. 2004 Feb 10;112(2):228-9 - PubMed
  99. BJOG. 2021 May;128(6):1066-1075 - PubMed
  100. Hepatology. 1997 Aug;26(2):358-64 - PubMed
  101. Pharmacogenetics. 2004 Feb;14(2):91-102 - PubMed
  102. Acta Obstet Gynecol Scand. 2012 Jun;91(6):679-85 - PubMed
  103. Gastroenterology. 2005 Sep;129(3):894-901 - PubMed
  104. J Hepatol. 2008 Jan;48(1):125-32 - PubMed
  105. MMWR Recomm Rep. 2016 Jul 29;65(3):1-103 - PubMed
  106. Eur J Obstet Gynecol Reprod Biol. 2020 Oct;253:117-120 - PubMed
  107. Sci Rep. 2017 Sep 18;7(1):11823 - PubMed
  108. Placenta. 2011 Dec;32(12):1026-32 - PubMed
  109. Obstet Gynecol. 2014 Jul;124(1):120-133 - PubMed
  110. Physiol Res. 2015;64(Suppl 2):S203-9 - PubMed
  111. PLoS One. 2020 Feb 19;15(2):e0228213 - PubMed
  112. Obstet Med. 2010 Mar;3(1):25-9 - PubMed
  113. J Hepatol. 2015 Aug;63(2):456-61 - PubMed
  114. Hautarzt. 2017 Feb;68(2):87-94 - PubMed
  115. J Pregnancy. 2012;2012:379271 - PubMed
  116. Gastroenterology. 2005 Aug;129(2):476-85 - PubMed
  117. Chest. 1993 Sep;104(3):919-24 - PubMed
  118. Am J Physiol. 1980 Apr;238(4):G321-5 - PubMed
  119. Curr Treat Options Gastroenterol. 2003 Apr;6(2):123-132 - PubMed
  120. BJOG. 2013 May;120(6):717-23 - PubMed
  121. Gastroenterology. 1991 Apr;100(4):1123-5 - PubMed
  122. Hepatology. 2004 Aug;40(2):467-74 - PubMed
  123. Rev Chil Obstet Ginecol. 1988;53(4):229-33 - PubMed
  124. Proc Natl Acad Sci U S A. 1998 Jan 6;95(1):282-7 - PubMed
  125. J Hepatol. 1989 Jul;9(1):84-90 - PubMed
  126. J Matern Fetal Neonatal Med. 2016;29(13):2176-81 - PubMed
  127. Obstet Med. 2019 Sep;12(3):123-128 - PubMed
  128. Gastroenterology. 2001 May;120(6):1448-58 - PubMed
  129. Gut. 2008 Jul;57(7):951-6 - PubMed
  130. Hepatology. 2012 Oct;56(4):1391-400 - PubMed
  131. Gastroenterology. 1986 Oct;91(4):825-9 - PubMed
  132. Obstet Gynecol. 2016 Nov;128(5):1048-1052 - PubMed

Publication Types