SECTION 2: INTRAHEPATIC CHOLESTASIS OF PREGNANCY （ICP）

1. Definition

Intrahepatic cholestasis is a condition characterized by accumulation of bile acids in the liver, with subsequent accumulation in the plasma, causing pruritus and jaundice. It is similar to the cholestasis that occasionally occurs during oral contraceptive therapy. Estrogen and progesterone are therefore considered to play a role in its etiology.

2. Diagnosis

Ultrasound examination of the gallbladder helps rule out cholelithiasis. If hepatitis is not present, the most likely diagnosis is cholestasis associated with pregnancy. Laboratory values show an increased alkaline phosphatase, bilirubin, and serum bile acids. AST and ALT may be elevated as well.

3. Treatment

Symptomatic treatment of pruritus with diphenhydramine is useful. Ursodeoxy cholic acid 300 mg twice a day has been shown to inhibit absorption of toxic bile acids and increase their biliary secretion. In doing so, the medication normalizes bile acids, improves liver function tests, and alleviates pruritus. Oral steroids have also been used to relieve symptoms. Cholestyramine is no longer routinely used. Symptoms resolve post partum.

Controversy surrouds the fetal effects of cholestasis. Most literature evidence a slight increase in preterm births and still-birth. The etiology is unclear, but some refer to the fetal toxicity of bile acids as a causative factor. Antenatal testing with a modified biophysical profile two times per week starting at the time of diagnosis is suggested. There is no agreement as to whether the pregnancy should be induced at 37-38 weeks or whether to await spontaneous labor.

（王皓）