scholarly journals Intrahepatic Cholestasis of Pregnancy: A Serious but Underestimated Problem

2012 ◽  
Vol 4 (2) ◽  
pp. 118-119
Author(s):  
Arti Sharma ◽  
Priyanka Choudhary ◽  
Rajiv Acharya ◽  
Anjali Choudhary ◽  
Anshoo Garg Gupta
Keyword(s):  
South Asian ◽  
Intrahepatic Cholestasis ◽  
Clinical Problem ◽  
Liver Disorder ◽  
Medical Intervention ◽  
Fetal Mortality ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Risk Condition ◽  
Substantial Risk ◽  
Cholestasis Of Pregnancy

ABSTRACT Intrahepatic cholestasis of pregnancy (IHCP) is the most common liver disorder unique to pregnancy. In spite of the substantial risk, IHCP remains widely disregarded as a serious clinical problem. We report a case of IHCP with deranged coagulation which resulted in maternal morbidity in the form of severe postpartum hemorrhage and fetal mortality. This case emphasizes the fact that IHCP should be considered a high-risk condition, and careful fetal assessment and appropriate medical intervention might—improve maternal and perinatal outcome. How to cite this article Acharya R, Sharma A, Choudhary P, Choudhary A, Gupta AG. Intrahepatic Cholestasis of Pregnancy: A Serious but Underestimated Problem. J South Asian Feder Obst Gynae 2012;4(2):118-119.

Association of ABCB4 and ABCB11 nucleotide variants with intrahepatic cholestasis of pregnancy

2019 ◽  
Vol 88 (4) ◽  
pp. 209-217
Author(s):  
Milena Gruszczyńska-Losy ◽  
Adrianna Mostowska ◽  
Łukasz Adamczak ◽  
Paweł Jagodziński ◽  
Ewa Wender-Ożegowska ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Intrahepatic Cholestasis ◽  
Clinical Symptoms ◽  
Melting Curve ◽  
Liver Disorder ◽  
Melting Curve Analysis ◽  
Control Group ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Increased Risk ◽  
Cholestasis Of Pregnancy

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.

Fetal complications due to intrahepatic cholestasis of pregnancy

2015 ◽  
Vol 43 (2) ◽  
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.

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

2016 ◽  
Vol 94 (4) ◽  
pp. 402-407 ◽  
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.

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

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.

scholarly journals The prevalence and pregnancy outcomes of intrahepatic cholestasis of pregnancy: A retrospective clinical audit review

2018 ◽  
Vol 12 (3) ◽  
pp. 123-128 ◽  
Author(s):  
Fergus W Gardiner ◽  
Ruth McCuaig ◽  
Chris Arthur ◽  
Thomas Carins ◽  
Adam Morton ◽  
...  
Keyword(s):  
South Asian ◽  
Intrahepatic Cholestasis ◽  
Tertiary Care ◽  
Special Care ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Indigenous Australian ◽  
Asian Ethnicity ◽  
Audit Review ◽  
Gestational Age At Delivery ◽  
Cholestasis Of Pregnancy

Background To determine the prevalence and outcomes of intrahepatic cholestasis of pregnancy. Methods A review comparing intrahepatic cholestasis of pregnancy pregnancies to all other pregnancies in three tertiary care Australian hospitals over a 36-month period. Results There were 43,876 pregnancies. The prevalence of intrahepatic cholestasis of pregnancies ( n = 319) was 0.7%. There were differences between intrahepatic cholestasis of pregnancy and non-intrahepatic cholestasis of pregnancy mothers including higher prevalence of South Asian (22.6% versus 3.1%, p < 0.001), Indigenous Australian (3.8% versus 1.8%, p < 0.05), and Asian ethnicity (8.4% versus 5.7%, p < 0.05), mothers with a body mass index >35 kg/m2 (10.6% versus 5.5%, p < 0.001), those with diabetes mellitus (25.7% versus 9.8%, p < 0.001), and those with twin births (8.7% versus 2.2%, p < 0.001). The primary clinical outcomes of intrahepatic cholestasis of pregnancy included a median gestational age at delivery of 36.4 (SE 0.09) weeks compared to 38.6 (SE 0.01) weeks (p < 0.001), a lower birth weight (3.12 (SE 0.03) versus 3.31 kg (SE 0.03), p < 0.001), and an increase in special care nursery admissions (44.5% versus 15.3%, p < 0.001). Conclusion Treated intrahepatic cholestasis of pregnancy in the population described here had similar mortality outcomes although increased special care nursery admission as compared to the general population.

scholarly journals Dermatoses of pregnancy. A prospective study from Benghazi, Libya

2019 ◽  
Vol 3 (6) ◽  
pp. 166
Author(s):  
Safa Suleman Elfaituri
Keyword(s):  
Prospective Study ◽  
Intrahepatic Cholestasis ◽  
Skin Diseases ◽  
Fetal Mortality ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Pemphigoid Gestationis ◽  
Fetal Risk ◽  
Atopic Eruption Of Pregnancy ◽  
A Prospective Study ◽  
Cholestasis Of Pregnancy

Introduction: Cutaneous findings in pregnancy can be physiologic, coincidental, alterations in pre-existing skin diseases or pregnancy specific. The Pregnancy dermatoses can impact the health of the pregnant woman and the fetus Objectives: Our objective was to determine the spectrum of skin disease associated with pregnancy and to identify the various types of pregnancy specific dermatoses and their fetal risk. Materials & methods: A prospective study was performed at dermatology out-patient department of Jumhoria hospital and Ibn Sina polyclinic, Benghazi-Libya over a period of 2 years. A total of 200 pregnant women presented with dermatological complaint were included. History, skin examination, and relevant investigations were performed. The patients with pregnancy specific dermatoses were followed up till delivery and the pregnancy outcome was recorded. The results were analyzed using SPSS. Results: Mean age was 32 years, 62% was multigravidae and 54% of pregnancy dermatoses occurred during third trimester. The highest number of cases presented with coincidental or preexisting diseases (71%); infections (34%), pre-existing skin diseases included eczema (13%), acne vulgaris (4%) and psoriasis (3%) Hyperpigmentation and strieagravidarum represented the main physiological changes (17%). Specific pregnancy dermatoses were present in 12%, these were intrahepatic cholestasis of pregnancy (4%), atopic eruption of pregnancy (3%), pemphigoid gestationis (3%) and polymorphic eruption of pregnancy (2%). Fetal complications including fetal mortality were reported with pemphigoid gestationis (30%) and intrahepatic cholestasis of pregnancy (25%). Conclusions: This study provides important data on the spectrum of pregnancy dermatoses in Libyan patients. Most of the reported pregnancy dermatoses were benign with no adverse effect on the fetus. Pemphigoid gestationis and intrahepatic cholestasis of pregnancy can be a source of significant fetal risk. To the best of our knowledge this is the first study carried out on pregnancy dermatoses in Benghazi, Libya.

scholarly journals Alpha-1 Antitrypsin Z Variant (AAT PI*Z) as a Risk Factor for Intrahepatic Cholestasis of Pregnancy

2021 ◽  
Vol 12 ◽  
Author(s):  
Przemyslaw Kosinski ◽  
Malgorzata Kedzia ◽  
Adrianna Mostowska ◽  
Pawel Gutaj ◽  
Michal Lipa ◽  
...  
Keyword(s):  
Intrahepatic Cholestasis ◽  
Fetal Monitoring ◽  
Fold Increase ◽  
Liver Disorder ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Increased Risk ◽  
Alpha 1 Antitrypsin Deficiency ◽  
Alpha 1 Antitrypsin ◽  
Cholestasis Of Pregnancy ◽  
In Pregnancy

Background: Intrahepatic cholestasis of pregnancy (ICP; prevalence 0.2–15.6%) is the most common pregnancy-related liver disorder. It may have serious consequences for a pregnancy, including increased risk of preterm delivery, meconium staining of amniotic fluid, fetal bradycardia, distress, and fetal demise. In cases of high bile acids (&gt;100μmol/L), patients have 10-fold increase in the risk of stillbirth. Biophysical methods of fetal monitoring, such as cardiotocography, ultrasonography, or Doppler have been proven unreliable for risk prediction in the course of intrahepatic cholestasis. Therefore, we believe extensive research for more specific, especially early, markers should be carried out. By analogy with cholestasis in children with inherited alpha-1 antitrypsin deficiency (AATD), we hypothesized the SERPINA1 Z pathogenic variant might be related to a higher risk of cholestasis in pregnancy. This study aimed to investigate the most common AATD variants (Z and S SERPINA1 alleles) in a group of cholestatic pregnant women.Results: The Z carrier frequency was calculated to be 6.8%, which is much higher compared to the general population [2.3%; the Chi-squared test with Yates correction is 6.8774 (p=0.008)].Conclusion: Increased prevalence of SERPINA1 PI*Z variant in a group of women with intrahepatic cholestasis may suggest a possible genetic origin of a higher risk of intrahepatic cholestasis in pregnancy.

scholarly journals Intrahepatic Cholestasis of Pregnancy: A Case Study of the Rare Onset in the First Trimester

Medicina ◽  
2019 ◽  
Vol 55 (8) ◽  
pp. 454 ◽  
Author(s):  
Milos Stulic ◽  
Djordje Culafic ◽  
Ivan Boricic ◽  
Milica Stojkovic Lalosevic ◽  
Nina Pejic ◽  
...  
Keyword(s):  
Bile Acids ◽  
Reference Values ◽  
Intrahepatic Cholestasis ◽  
First Trimester ◽  
Liver Disorder ◽  
Total Serum ◽  
Serum Bile Acid ◽  
Close Monitoring ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Cholestasis Of Pregnancy

Intrahepatic cholestasis of pregnancy (ICP) is a gestation-specific liver disorder, defined most often as the onset of pruritus, usually from the third trimester of pregnancy, associated with abnormal liver test results and/or increased total serum bile acids and spontaneous relief after delivery. The 21-year-old patient was admitted to our ward in the 11th week of pregnancy due to raised liver enzymes. The first onset of pruritus and jaundice appeared a month before hospitalization. Immunology tests and Toxoplasma gondii were negative. We excluded viral etiology, while alpha-1-antitrypsin, serum and urine copper levels, and thyroid hormones were within the reference values. The patient denied she had taken any medicines and herbal preparations before and during pregnancy. Total bile acids in the serum were significantly elevated (242 μmol/L). The abdominal ultrasound revealed a regular finding. Liver biopsy suggested a cholestatic liver disorder. After a presentation of all risks, the patient decided to stop the pregnancy. After a month, the hepatogram was within the reference values. Very rarely an ICP can occur in early pregnancy (first trimester), which calls for close monitoring. The risk of serious adverse fetal outcomes and spontaneous preterm delivery is proportional with increased levels of maternal serum bile acid.

Celastrol Attenuates Intrahepatic Cholestasis of Pregnancy by Inhibiting Matrix Metalloproteinases-2 and 9

2018 ◽  
Vol 17 (5) ◽  
pp. 0-10
Author(s):  
Junjun Guo ◽  
Yong Wang ◽  
Na Wang ◽  
Yulai Bai ◽  
Dandan Shi
Keyword(s):  
Intrahepatic Cholestasis ◽  
Bile Flow ◽  
Liver Disorder ◽  
Model Material ◽  
Female Rats ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Strong Correlations ◽  
Bile Flow Rate ◽  
The Impact ◽  
Cholestasis Of Pregnancy

Introduction and aim. Matrix metalloproteinase (MMP)-2 and MMP-9 are reported to participate in several pregnancy-related diseases, including intrahepatic cholestasis of pregnancy (ICP), which is a severe liver disorder in pregnant women. Meanwhile, ample evidences have demonstrated that celastrol inhibits the activity and expression of MMPs. The present study aims to examine the effect of celastrol to alleviate symptoms of ICP in rat model. Material and methods. By inducing ICP with 17 - ethinylestradiol in pregnant female rats, we assessed the impact of celastrol administration on symptoms of ICP, such as the rate of bile flow, the level of total bile acids (TBA), and the activities of MMP-2 and -9. Furthermore, the correlations between the levels of MMPs with the examined ICP symptoms were investigated. Results. In rats with ICP, both MMP-2 and -9 exhibited significantly elevated activities, which were inhibited by the administration of celastrol. Furthermore, ICP symptoms such as bile flow rate and total TBA were restored by celastrol. Lastly, there were strong correlations between levels of the two MMPs and TBA. Conclusion. Our findings described for the first time the effects of celastrol to attenuate ICP symptoms through an inhibition of both MMP-2 and -9, providing evidence for a potential role of celastrol as a new drug for the treatment of ICP.

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