title: Review of a challenging clinical issue: Intrahepatic cholestasis of pregnancy.
abstract: Intrahepatic cholestasis of pregnancy (ICP) is a reversible pregnancy-specific cholestatic condition characterized by pruritus, elevated liver enzymes, and increased serum bile acids. It commences usually in the late second or third trimester, and quickly resolves after delivery. The incidence is higher in South American and Scandinavian countries (9.2%-15.6% and 1.5%, respectively) than in Europe (0.1%-0.2%). The etiology is multifactorial where genetic, endocrine, and environmental factors interact. Maternal outcome is usually benign, whereas fetal complications such as preterm labor, meconium staining, fetal distress, and sudden intrauterine fetal demise not infrequently lead to considerable perinatal morbidity and mortality. Ursodeoxycholic acid is shown to be the most efficient therapeutic agent with proven safety and efficacy. Management of ICP consists of careful monitoring of maternal hepatic function tests and serum bile acid levels in addition to the assessment of fetal well-being and timely delivery after completion of fetal pulmonary maturity. This review focuses on the current concepts about ICP based on recent literature data and presents an update regarding the diagnosis and management of this challenging issue.
authors.affiliation: Sebiha Ozkan, Yasin Ceylan, Sule Yildirim, Department of Obstetrics and Gynecology, School of Medicine, Kocaeli University, Izmit 41380, Kocaeli, Turkey.
authors.forename: Sebiha
authors.initials: S
authors.lastname: Ozkan
authors.affiliation: Sebiha Ozkan, Yasin Ceylan, Sule Yildirim, Department of Obstetrics and Gynecology, School of Medicine, Kocaeli University, Izmit 41380, Kocaeli, Turkey.
authors.forename: Yasin
authors.initials: Y
authors.lastname: Ceylan
authors.affiliation: Sebiha Ozkan, Yasin Ceylan, Sule Yildirim, Department of Obstetrics and Gynecology, School of Medicine, Kocaeli University, Izmit 41380, Kocaeli, Turkey.
authors.forename: Orhan Veli
authors.initials: OV
authors.lastname: Ozkan
authors.affiliation: Sebiha Ozkan, Yasin Ceylan, Sule Yildirim, Department of Obstetrics and Gynecology, School of Medicine, Kocaeli University, Izmit 41380, Kocaeli, Turkey.
authors.forename: Sule
authors.initials: S
authors.lastname: Yildirim
mesh_terms: D002756:Cholagogues and Choleretics / Q000627:therapeutic use; D002780:Cholestasis, Intrahepatic / Q000175:diagnosis / Q000453:epidemiology / Q000235:genetics / Q000628:therapy; D005260:Female; D005819:Genetic Markers; D020022:Genetic Predisposition to Disease; D006801:Humans; D015994:Incidence; D010641:Phenotype; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000453:epidemiology / Q000235:genetics / Q000628:therapy; D012307:Risk Factors; D016896:Treatment Outcome; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
chemical_list: D002756:Cholagogues and Choleretics; D005819:Genetic Markers; D014580:Ursodeoxycholic Acid
keywords: Cholestasis; Diagnosis; Intrahepatic; Management; Pregnancy