Intrahepatic cholestasis of pregnancy – Diagnosis and management: A consensus statement of the Society of Obstetric Medicine of Australia and New Zealand (SOMANZ): Executive summary

William M Hague, Annette Briley, Leonie Callaway, Marloes Dekker Nitert, Jessica Gehlert, Dorothy Graham, Luke Grzeskowiak, Angela Makris, Corey Markus, Philippa Middleton, Michael J. Peek, Antonia Shand, Michael Stark, Jason Waugh

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Abstract

•Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy liver disease, characterised by pruritus and increased total serum bile acids (TSBA), Australian incidence 0.6–0.7%. 

•ICP is diagnosed by non-fasting TSBA ≥19 μmol/L in a pregnant woman with pruritus without rash without a known pre-existing liver disorder. 

•Peak TSBA ≥40 and ≥100 μmol/L identify severe and very severe disease respectively, associated with spontaneous preterm birth when severe, and with stillbirth, when very severe. 

•Benefit-vs-risk for iatrogenic preterm birth in ICP remains uncertain. 

•Ursodeoxycholic acid remains the best pharmacotherapy preterm, improving perinatal outcome and reducing pruritus, although it has not been shown to reduce stillbirth.

Original languageEnglish
Pages (from-to)656-665
Number of pages10
JournalAustralian and New Zealand Journal of Obstetrics and Gynaecology
Volume63
Issue number5
Early online date11 Jul 2023
DOIs
Publication statusPublished - Oct 2023

Keywords

  • pregnancy
  • pruritus
  • stillbirth
  • total serum bile acids
  • ursodeoxycholic acid

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