[Intrahepatic cholestasis in pregnancy. The hepatologist's point of view].
Intra-hepatic cholestasis of pregnancy (ICP) is a specific liver disease that occurs in the third trimester of pregnancy (less frequently in the second trimester) and disappears quickly after delivery. Cholestasis can occur in pregnancy in three situations: a chronic liver disease brought out during pregnancy, intercurrent liver disease or ICP. The serum levels of alanine aminotransferase (ALT) and total bile salts are the most sensitive tests for diagnosing cholestasis in pregnancy. Collaboration between the obstetric team and the liver doctor is needed to find a cause or a factor that increases the risk of cholestasis. Urinary tract infections should always be ruled out. Oral hormonal treatments in pregnancy have not been clearly established as a cause and further investigations are continuing. The maternal prognosis is excellent, but it is important to monitor the prothrombin time and treat any vitamin K deficiency. On the other hand, the fetal prognosis is less good and there is an increase in prematurity and intra-uterine fetal death. When a diagnosis of cholestasis has been confirmed we advise immediately cessation of hormone treatments including natural progesterone. We describe the principals of medical and obstetric management.
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Service d'Hépatogastroentérologie, Hôpital Trousseau, Tours.
D000410:Alanine Transaminase / Q000097:blood; D001647:Bile Acids and Salts / Q000097:blood; D002780:Cholestasis, Intrahepatic / Q000097:blood / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D003937:Diagnosis, Differential; D005260:Female; D005762:Gastroenterology; D006728:Hormones / Q000009:adverse effects; D006801:Humans; D008107:Liver Diseases / Q000150:complications; D010348:Patient Care Team; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D015995:Prevalence; D011379:Prognosis; D011517:Prothrombin Time; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014813:Vitamin K Deficiency / Q000097:blood / Q000188:drug therapy / Q000209:etiology
D001647:Bile Acids and Salts; D006728:Hormones; D000410:Alanine Transaminase
La cholestase intra-hépatique gravidique. Le point de vue de l'hépatologue.