View source for Cholestasis of pregnancy/en

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==Background==

*Caused by combination of hormonal, genetic, and environmental factors --> impaired bile flow --> deposition of bile salts in skin and placenta
*May predispose mothers to [[Special:MyLanguage/vitamin K deficiency|vitamin K deficiency]] and increase risk of preterm delivery, [[Special:MyLanguage/IUFD|IUFD]], and neonatal [[Special:MyLanguage/respiratory distress syndrome|respiratory distress syndrome]]<ref>http://bestpractice.bmj.com/topics/en-us/800</ref>

{{Gallbladder disease types}}


==Clinical Features==

*Typically develops in late second and/or 3rd trimester
*Rapidly resolves after delivery
*[[Special:MyLanguage/Pruritus|Pruritus]], starts and predominates on palms and soles
*[[Special:MyLanguage/RUQ pain|RUQ pain]]
*[[Special:MyLanguage/Nausea|Nausea]]
*[[Special:MyLanguage/Jaundice|Jaundice]]


==Differential Diagnosis==

{{Jaundice DDX}}


===Pregnancy-specific pruritus===

''see also: [[Special:MyLanguage/Rashes of pregnancy|Rashes of pregnancy]]''
*Pruritus gravidarum
*Atopic eruption of pregnancy
*Polymorphic eruption of pregnancy
*Pemphigoid gestationis
*Prurigo of pregnancy
*Pruritic folliculitis of pregnancy


==Evaluation==

*CBC (rule out thrombocytopenia)
*[[Special:MyLanguage/LFTs|LFTs]]
**Elevated total bile acid concentration
**Aminotransferases usually <2x upper limit of normal
**Alk phos and bili may be elevated
**GGT normal or modestly elevated
**[[Special:MyLanguage/RUQ US|RUQ US]] normal, no biliary duct dilation


==Management==

*Ursodeoxycholic acid ([[Special:MyLanguage/ursodiol|ursodiol]]) 300mg TID until delivery
*OBGYN follow-up


==Disposition==

*Discharge with OBGYN follow-up


==See Also==


==External Links==


==References==

https://www.uptodate.com/contents/intrahepatic-cholestasis-of-pregnancy
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[[Category:OBGYN]] [[Category:GI]]