77: The risk of infant and fetal death by each additional week of expectant management in intrahepatic cholestasis of pregnancy stratified by gestational age

Objectives We report on a patient suffering from intractable itching secondary to intrahepatic cholestasis of pregnancy (ICP) unresponsive to conventional medical therapies. She was started on a regimen of therapeutic plasma exchange (TPE), which is often efficacious in relieving patient's itching from all causes of cholestasis, including ICP. Methods We performed a retrospective review of a patient's medical record. Results Following initial TPE, the patient reported dramatic relief of her itching and consequent insomnia. However, this effect was short lived, as subsequent TPE provided minimal relief, and may have actually worsened her itching. Out of concern for poor fetal outcomes, delivery was induced at 34 weeks gestational age. The child had an uncomplicated neonatal intensive care unit stay following delivery, and the mother reported > 90% relief of her symptoms 2 weeks after delivery. Conclusion TPE often provides longer term relief of itching because of ICP; however, it is not a panacea for these symptoms, and sometimes only delivery of the fetus can relieve maternal symptoms. In addition to the refractoriness to TPE, the case is also unusual for the early onset of ICP symptoms and the comorbidity of hepatitis C.

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Sudden fetal death in a patient with intrahepatic cholestasis of pregnancy complicated with gestational diabetes mellitus

Archives of Gynecology and Obstetrics ◽

10.1007/s00404-012-2507-z ◽

2012 ◽

Vol 287 (1) ◽

pp. 179-182 ◽

Cited By ~ 2

Author(s):

Jianyang Lu ◽

Hongbo Qi

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Intrahepatic Cholestasis ◽

Fetal Death ◽

Intrahepatic Cholestasis Of Pregnancy ◽

Cholestasis Of Pregnancy

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May Circulating Steroids Reveal a Predisposition to Intrahepatic Cholestasis of Pregnancy in Non-Pregnant Women?

Physiological Research ◽

10.33549/physiolres.934028 ◽

2018 ◽

pp. S499-S510

Author(s):

P. ŠIMJÁK ◽

M. HILL ◽

A. PAŘÍZEK ◽

L. VÍTEK ◽

M. VELÍKOVÁ ◽

...

Keyword(s):

Gestational Age ◽

Intrahepatic Cholestasis ◽

Liver Disorder ◽

Maternal Blood ◽

Gas Chromatography Mass Spectrometry ◽

Intrahepatic Cholestasis Of Pregnancy ◽

Third Trimester ◽

Umbilical Blood ◽

Subject Factor ◽

Cholestasis Of Pregnancy

Intrahepatic cholestasis of pregnancy (ICP) is a frequent liver disorder, mostly occurring in the third trimester. ICP is not harmful to the mothers but threatens the fetus. The authors evaluated steroid alterations in maternal and mixed umbilical blood to elucidate their role in the ICP development. Ten women with ICP were included in the study. Steroids in the maternal blood were measured by Gas Chromatography-Mass Spectrometry (GC-MS) (n=58) and RIA (n=5) at the diagnosis of ICP, labor, day 5 postpartum, week 3 postpartum and week 6 postpartum. The results were evaluated by ANOVA consisting of the subject factor, between subject factors ICP, gestational age at the diagnosis of ICP and gestational age at labor, within-subject factor Stage and ICP × Stage interaction. The 17 controls were firstly examined in the week 36 of gestation. ICP patients showed reduced CYP17A1 activity in the C17,20 lyase step thus shifting the balance between the toxic conjugated pregnanediols and harmless sulfated 5α/β-reduced-17-oxo C19 steroids. Hence, more toxic metabolites originating in maternal liver from the placental pregnanes may penetrate backward to the fetal circulation. As these alterations persist in puerperium, the circulating steroids could be potentially used for predicting the predisposition to ICP even before next pregnancy.

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