scholarly journals Predictors of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy

2019 ◽  
Vol 90 (4) ◽  
pp. 217-222 ◽  
Author(s):  
Samettin Çelik ◽  
Canan S. Çalışkan ◽  
Handan Çelik ◽  
Mehmet Güçlü ◽  
Alper Başbuğ
Keyword(s):  
Intrahepatic Cholestasis ◽  
Perinatal Outcomes ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Adverse Perinatal Outcomes ◽  
Cholestasis Of Pregnancy

scholarly journals Intrahepatic cholestasis of pregnancy

2021 ◽  
Vol 16 (S3) ◽  
pp. 50-55
Author(s):  
Ana Maria SCUTELNICU ◽  
◽  
Brînduşa Ana CIMPOCA-RAPTIS ◽  
Anca Marina CIOBANU ◽  
Nicolae GICĂ ◽  
...  
Keyword(s):  
Pregnancy Outcomes ◽  
Intrahepatic Cholestasis ◽  
Perinatal Outcomes ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Fetal Asphyxia ◽  
Increased Risk ◽  
Adverse Perinatal Outcomes ◽  
Adverse Pregnancy ◽  
Cholestasis Of Pregnancy ◽  
Meconium Stained Amniotic Fluid

Intrahepatic cholestasis of pregnancy is the most common liver disease during pregnancy. The main features are maternal pruritus, in the absence of a rash, and raised serum bile acids. Intrahepatic cholestasis of pregnancy is associated with an increased risk of adverse perinatal outcomes, including preterm birth, meconium-stained amniotic fluid, fetal asphyxia with neonatal unit admission or even stillbirth. The main treatment option is ursodeoxycholic acid. We review the etiology, diagnosis, adverse pregnancy outcomes, focusing especially on management of this intriguing condition.

scholarly journals Early Onset of Intrahepatic Cholestasis of Pregnancy: a Case Report

2021 ◽  
Author(s):  
Maria Cemortan ◽  
Liudmila Stavinskaia ◽  
Irina Sagaidac ◽  
Olga Cernetchi
Keyword(s):  
Pregnancy Outcomes ◽  
Intrahepatic Cholestasis ◽  
Perinatal Outcomes ◽  
Liver Function Tests ◽  
High Rate ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
High Incidence ◽  
Elevated Liver Function Tests ◽  
Adverse Perinatal Outcomes ◽  
Cholestasis Of Pregnancy

Abstract Intrahepatic cholestasis of pregnancy (ICP) is a disorder characterized by pruritus and elevated liver function tests. Associated with a high incidence of adverse perinatal outcomes, ICP requires thorough attention in clinical practice. In addition, there is a high rate of stillbirth in cases of ICP. Women with ICP should be informed of the inability to predict stillbirth. Multi-disciplinary cooperation is critical for managing the condition and ensuring better pregnancy outcomes.

scholarly journals Ursodeoxycholic acid to reduce adverse perinatal outcomes for intrahepatic cholestasis of pregnancy: the PITCHES RCT

2020 ◽  
Vol 7 (9) ◽  
pp. 1-42
Author(s):  
Lucy C Chappell ◽  
Jennifer L Bell ◽  
Anne Smith ◽  
Catherine Rounding ◽  
Ursula Bowler ◽  
...  
Keyword(s):  
Placebo Group ◽  
Ursodeoxycholic Acid ◽  
Intrahepatic Cholestasis ◽  
Primary Outcome ◽  
Perinatal Outcomes ◽  
Acid Group ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Significant Difference ◽  
Adverse Perinatal Outcomes ◽  
Cholestasis Of Pregnancy

Background Intrahepatic cholestasis of pregnancy, characterised by maternal pruritus and raised serum bile acid concentrations, is associated with increased rates of stillbirth, preterm birth and neonatal unit admission. Ursodeoxycholic acid is widely used as a treatment, but without an adequate evidence base. Objective We aimed to evaluate whether or not ursodeoxycholic acid reduces adverse perinatal outcomes in affected women. Design Multicentre, masked, randomised, placebo-controlled, two-arm, parallel-group trial. Setting Thirty-three UK maternity units. Participants Women with intrahepatic cholestasis of pregnancy aged ≥ 18 years, between 20+0 and 40+6 weeks’ gestation with a singleton or twin pregnancy and no known lethal fetal anomaly. Interventions Women were randomly assigned (1 : 1 allocation ratio) to take ursodeoxycholic acid tablets or matched placebo tablets, at an equivalent dose of 1000 mg daily, titrated as needed. Main outcome measures The primary outcome was a composite of perinatal death (in utero fetal death after randomisation or known neonatal death up to 7 days) or preterm delivery (< 37 weeks’ gestation) or neonatal unit admission for at least 4 hours (from birth until hospital discharge). Each infant was counted once within this composite. Analyses were by intention to treat. Results Between 23 December 2015 and 7 August 2018, 605 women were randomised, with 305 women allocated to the ursodeoxycholic acid arm and 300 women to the placebo arm. There was no evidence of a significant difference in the incidence of the primary outcome between the groups: 23.0% (74 out of 322 infants) in the ursodeoxycholic acid group compared with 26.7% (85 out of 318 infants) in the placebo group; adjusted risk ratio 0.85 (95% confidence interval 0.62 to 1.15). There was no evidence of a significant difference in total costs (maternal, infant and the cost of ursodeoxycholic acid) between the two trial groups. There were two serious adverse events in the ursodeoxycholic acid group and six in the placebo group. Limitations Limitations include a primary outcome event rate in the control group that was lower than that estimated for the sample size calculation, but the lack of evidence of effect in all analyses suggests that it is unlikely that the trial had insufficient power. Conclusions In this clinical trial of ursodeoxycholic acid in women with intrahepatic cholestasis of pregnancy, there is no evidence that it is effective in reducing a composite of adverse perinatal outcomes. Future work Future research should aim to elucidate the aetiology and pathophysiology of adverse perinatal outcomes, particularly stillbirth, in women with intrahepatic cholestasis of pregnancy to assist the development of an effective preventative treatment. Further exploratory analyses may identify groups of women who might respond to ursodeoxycholic acid treatment. Trial registration Current Controlled Trials ISRCTN91918806. Funding This project was funded by the Efficacy and Mechanism Evaluation (EME) Programme, a Medical Research Council and National Institute for Health Research (NIHR) partnership. This will be published in full in Efficacy and Mechanism Evaluation; Vol. 7, No. 9. See the NIHR Journals Library website for further project information.

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