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World J Gastroenterol. Jun 21, 2015; 21(23): 7134-7141
Published online Jun 21, 2015. doi: 10.3748/wjg.v21.i23.7134
Review of a challenging clinical issue: Intrahepatic cholestasis of pregnancy
Sebiha Ozkan, Yasin Ceylan, Orhan Veli Ozkan, Sule Yildirim
Sebiha Ozkan, Yasin Ceylan, Sule Yildirim, Department of Obstetrics and Gynecology, School of Medicine, Kocaeli University, Izmit 41380, Kocaeli, Turkey
Orhan Veli Ozkan, Department of General Surgery, Faculty of Medicine, Sakarya University, Sakarya 54187, Turkey
Author contributions: Ozkan S and Ozkan OV designed and wrote the article; Ozkan S, Ceylan Y and Yildirim S reviewed and summarized the literature data, and wrote the paper; Ozkan OV helped to write the manuscript and performed final preparations before submitting the manuscript.
Conflict-of-interest: No potential conflicts-of-interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Orhan Veli Ozkan, Associate Professor, Department of General Surgery, Faculty of Medicine, Sakarya University, Adnan Menderes Caddesi, Saglik Sokak No. 193, Sakarya 54187, Turkey. veliorhan@hotmail.com
Telephone: +90-532-3417440 Fax: +90-264-2552105
Received: January 27, 2015
Peer-review started: January 27, 2015
First decision: February 10, 2015
Revised: March 4, 2015
Accepted: April 17, 2015
Article in press: April 17, 2015
Published online: June 21, 2015
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.

Keywords: Intrahepatic, Cholestasis, Pregnancy, Diagnosis, Management

Core tip: Intrahepatic cholestasis of pregnancy (ICP) is a unique hepatic disorder in pregnancy characterized by pruritus, elevated liver enzymes, and serum bile acids. It usually appears in the third trimester and dissolves rapidly after delivery. The incidence is variable between 0.1%-15.6% in different geographic regions of the world. Genetic, hormonal, and environmental factors interact in its etiopathogenesis. A considerable incidence of perinatal morbidity-mortality makes it one of the most concerning obstetric entities for obstetricians and critical care specialists. Timely diagnosis and expert multidisciplinary management of pregnant women with ICP is mandatory to ensure a favorable maternal-fetal outcome.