Management of intrahepatic cholestasis in pregnancy

Kirsten R. Palmer, Liu Xiaohua, Ben W. Mol

Research output: Contribution to journalComment/debatepeer-review

29 Citations (Scopus)


Intrahepatic cholestasis of pregnancy is a complication
in 0·2–2% of pregnancies, 1 causing pruritis and
increased serum bile acids, liver transaminases, and,
occasionally, bilirubin. It has been associated with severe
adverse pregnancy outcomes, including fetal distress,
spontaneous and iatrogenic preterm birth, and still -
birth,1 for which no effective treatment is yet known. 2
Ursodeoxycholic acid, which is regularly prescribed,
improves biochemical parameters and reduces, although
on a limited scale (evidence is conflicting), pruritis. 3
Antenatal fetal monitoring strategies have not proven
effective, resulting in substantial variation in the
timing of delivery due to attempts to balance risks of
stillbirth against increasingly understood neonatal and
childhood complications from late preterm and early
term delivery.4,5 This problem is reflected in the scarcity of
national guidelines worldwide. The guidelines published
in 2011 by the Royal College of Obstetricians and
Gynaecologists encourage open discussion with women
about the scarce evidence supporting early term delivery
to minimise stillbirth risk. 6 However, subsequent authors
have used decision analytic techniques to recommend
delivery at 36 weeks of gestation.7
Original languageEnglish
Pages (from-to)853-854
Number of pages2
JournalThe Lancet
Issue number10174
Early online date14 Feb 2019
Publication statusPublished - 2 Mar 2019


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