The Recurrent Liver Disorder of a Pregnant Mother: Intrahepatic Cholestasis of Pregnancy – A Case Report and Literature Review

Background: Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disorder during gestation. The exact pathogenesis of ICP is multifactorial and still unclear. Therefore, our study aimed to check whether the selected ABCB4and ABCB11nucleotide variants are associated with an increased risk of ICP. Methods:ICP was diagnosed based on clinical symptoms characteristic of this disease and confirmed by increase in serum bile acids and transaminases, spontaneous resolution of clinical symptoms and normalization of laboratory tests after delivery. The total of 86 pregnant women meeting the criteria were included into the study. Healthy pregnant women with uncomplicated pregnancy served as control group (n=310). Sixcommon nucleotide variants in theABCB11and ABCB4genes were genotypedwith the use of high-resolution melting curve analysis. Conclusion:Our study did not show any significant association of analysed ABCB4and ABCB11nucleotide variants with the increased risk of intrahepatic cholestasis of pregnancy.

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Medically Refractaory Pruritis from Intrahepatic Cholestasis of Pregnancy Successfully Treated with Plasmapheresis: A Case Report

The American Journal of Gastroenterology ◽

10.14309/00000434-201210001-01081 ◽

2012 ◽

Vol 107 ◽

pp. S436

Author(s):

Timothy Dougherty ◽

Samir Patel ◽

Susanne Bathgate ◽

Khaled El-Shami ◽

Marie Borum

Keyword(s):

Case Report ◽

Intrahepatic Cholestasis ◽

Intrahepatic Cholestasis Of Pregnancy ◽

Cholestasis Of Pregnancy

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A case report of early onset intrahepatic cholestasis of pregnancy

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/fetalneonatal-2012-301809.203 ◽

2012 ◽

Vol 97 (Suppl 1) ◽

pp. A63.2-A63

Author(s):

AWI Edoo ◽

M Imcha ◽

A Ali ◽

G Burke ◽

A Cotter ◽

...

Keyword(s):

Case Report ◽

Intrahepatic Cholestasis ◽

Early Onset ◽

Intrahepatic Cholestasis Of Pregnancy ◽

Cholestasis Of Pregnancy

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Fetal complications due to intrahepatic cholestasis of pregnancy

Journal of Perinatal Medicine ◽

10.1515/jpm-2014-0089 ◽

2015 ◽

Vol 43 (2) ◽

Cited By ~ 17

Author(s):

Patrik Šimják ◽

Antonín Pařízek ◽

Libor Vítek ◽

Andrej Černý ◽

Karolína Adamcová ◽

...

Keyword(s):

Intrahepatic Cholestasis ◽

Current Knowledge ◽

Elevated Serum ◽

Liver Function Tests ◽

Liver Disorder ◽

Intrauterine Fetal Death ◽

Intrahepatic Cholestasis Of Pregnancy ◽

Management Options ◽

Fetal Complications ◽

Cholestasis Of Pregnancy

AbstractIntrahepatic cholestasis of pregnancy (ICP) is the most common liver disorder of pregnancy. Diagnosis is based on the clinical picture, particularly the presence of pruritus with a deterioration of liver function tests, and typically elevated serum levels of total bile acids. ICP manifests in the second half of pregnancy, predominantly during the third trimester. Symptoms of the disease resolve spontaneously after delivery. Etiology is still not fully understood. Genetic defects in specific transport proteins, elevated levels of sex hormones, and various environmental factors are thought to play a role in the development of this disorder. Although practically benign for the pregnant woman, ICP represents a serious threat to the fetus. It increases the risk of preterm delivery, meconium excretion into the amniotic fluid, respiratory distress syndrome, and sudden intrauterine fetal death. Identifying fetuses at risk of ICP complications remains challenging. The ideal obstetrical management of ICP needs to be definitively determined. The aim of this review is to summarize the current knowledge on fetal complications of ICP and describe management options for their prevention.

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Resveratrol reduces matrix metalloproteinases and alleviates intrahepatic cholestasis of pregnancy in rats

Canadian Journal of Physiology and Pharmacology ◽

10.1139/cjpp-2015-0454 ◽

2016 ◽

Vol 94 (4) ◽

pp. 402-407 ◽

Cited By ~ 9

Author(s):

Zhong Chen ◽

Lingqing Hu ◽

Mudan Lu ◽

Zongji Shen

Keyword(s):

Ursodeoxycholic Acid ◽

Flow Rate ◽

Intrahepatic Cholestasis ◽

Bile Flow ◽

Liver Disorder ◽

Enzymatic Activities ◽

Intrahepatic Cholestasis Of Pregnancy ◽

Resveratrol Treatment ◽

Bile Flow Rate ◽

Cholestasis Of Pregnancy

Intrahepatic cholestasis of pregnancy (ICP) is a severe liver disorder occurring specifically in pregnancy, and matrix metalloproteinase (MMP)-2 and MMP-9 were found to be elevated in ICP patients. Using ethinylestradiol-induced ICP rats as the model, we examined the effect of resveratrol on ICP symptoms such as bile flow rate, serum enzymatic activities, and TBA concentration, as well as MMP levels, and compared with the known ICP drug ursodeoxycholic acid. Both MMP-2 and MMP-9 were upregulated in ICP rats, and resveratrol treatment could inhibit the elevation of both MMPs, whereas ursodeoxycholic acid did not exhibit any effect. Although ursodeoxycholic acid alleviated ICP symptoms, resveratrol treatment in general exhibited better outcome in restoring bile flow rate, serum enzymatic activities, and TBA concentration. Our results for the first instance strongly supported the potential of RE as a new therapeutic agent in treating ICP, possibly through inhibiting MMP-2 and MMP-9.

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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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