Cholestasis of Pregnancy

Intrahepatic cholestasis of pregnancy (ICP) appears in the second and third trimester of pregnancy and is characterized by pruritus and an increase of serum bile acid concentration. Cholestasis is associated with many hepatic-biliary disorders that produce extrahepatic biliary tract obstruction and/or intrahepatic biliary perturbation. A key symptom associated with cholestasis is pruritus, and could range in severity from mild to moderate (i. e. where sleep is disrupted) and to extreme (i. e. when the lifestyle of the patient is completely disrupted). It is often generalized but predominates on the palms and soles and manifests more violently at night. Pruritus may precede laboratory abnormalities. Total serum concentration of bile acid increase in cholestasis of pregnancy and may be the first or only laboratory abnormality. Other laboratory results reflecting cholestasis may also be present. These include increases in serum alkaline phosphatase (ALKP), total and direct bilirubin concentration. However, uncommonly, serum levels of gamma- glutamyl transpeptidase (GGT) are normal or slightly elevated, which is unusual in many other forms of cholestatic liver disease in which GGT levels are similar to other cholestatic markers. Most women are diagnosed in the second or third trimester of pregnancy.