Clinical features
Pruritus in pregnancy is common, affecting 23% of pregnancies, of which a small proportion will have obstetric cholestasis (1)
- pruritus of obstetric cholestasis is typically worse at night, is often widespread and may involve the palms of the hands and/or the soles of the feet
- women present with pruritus without rash, characteristically after 30 weeks' gestation
- pruritus often worsens as the pregnancy progresses
pruritus that involves the palms and soles of the feet is particularly suggestive
- steatorrhoea and dark urine may occur
- jaundice is a rare symptom (2)
- increased rates of postpartum haemorrhage have been postulated to be due to vitamin K deficiency
- gallstones may be present more often in affected women
- women with hepatitis C infection have a higher incidence of intrahepatic cholestasis of pregnancy (2)
- preeclampsia and gestational diabetes are seen more commonly in women with intrahepatic cholestasis of pregnancy (2)
Reference:
- Royal College of Obstetricians and Gynaecologists. Intrahepatic cholestasis of pregnancy (Green-top Guideline No. 43). Published August 2022
- Walker KF et al. Pharmacological interventions for treating intrahepatic cholestasis of pregnancy. Cochrane Database of Systematic Reviews 2020, Issue 7. Art. No.: CD000493. DOI: 10.1002/14651858.CD000493.pub3.