| Pathophysiology | • Likely due to increased estrogen and progesterone levels that cause hepatobiliary tract stasis and decreased bile excretion. |
|---|---|
| Risk factors | • prior ICP |
| • maternal age ≥35 | |
| • multiple gestation | |
| Clinical features | • Development in 3rd trimester because highest hormone levels in 3rd |
| • Generalized intractable pruritus | |
| • Pruritus worse on hands & feet | |
| • No associated rash | |
| • Right upper quadrant pain | |
| Laboratory abnormalities | • ↑ Total bile acids (≥10 µmol/L) |
| • ↑ Liver transaminases (typically <2x normal, rarely >1000 U/L) | |
| • ± ↑ Total & direct bilirubin | |
| Obstetric risks | does not increase the risk of maternal complications; however, due to transplacental passage of bile acids, it does increase the risk of fetal complications |
| • Intrauterine fetal demise | |
| • Preterm delivery | |
| • Meconium-stained amniotic fluid | |
| • Neonatal respiratory distress syndrome | |
| Management | • Ursodeoxycholic acid (improves pruritus and may decrease obstetric complications) |
| • Antihistamines | |
| • Regular fetal assessment (eg, nonstress test) | |
| • Delivery at 37 weeks gestation |
Alkaline phosphatase is often elevated but is not specific for ICP because it is also produced by the placenta.
<aside> 💡 Topical corticosteroids do not improve pruritis associated with ICP.
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