Intrahepatic Cholestasis of Pregnancy: Advances in Diagnosis and Management

Intra hepatic cholestasis of pregnancy (ICP) is considered to be the most common liver disease affecting pregnancy. While a number of genetic, hormonal and environmental factors have been found to influence the prevalence of ICP, the aetiology is still not fully known. High levels of circulating estrogen seen during the later part of second trimester and third trimester of pregnancy are believed to play a role in inducing cholestasis. The presenting complaints are of itching especially of palms and soles. Total serum bile acid (TSBA) levels are raised in patients of ICP and TSBA is considered the most sensitive and specific marker for the diagnosis of ICP (fasting serum bile acid concentrations greater than 10 μmol/L). While the itching tends to be self limited and often resolves after delivery, it has the tendency of producing adverse effects on the foetus. ICP can lead to spontaneous preterm birth, meconium-stained amniotic fluid, increased rates of caesarean sections and fetal distress which may end up in stillbirth. While a number of therapeutic agents have been used for controlling the itching, only ursodeoxycholic acid (UDCA) has been found to be effective in controlling maternal itching. Termination of pregnancy after completed 37 weeks of gestation is an acceptable line of management. Recent advances have seen attempts to identify the exact etiology of ICP, the best modality for diagnosis and prognostication, and treatment modalities. This article reviews the available diagnostic and management options and looks into the recent advances.