Intrahepatic cholestasis of pregnancy -a review

Abstract

A 32-year-old lady presented to the delivery suite at 36 weeks gestation with severe generalised pruritis. The itching was widespread, over her whole body, but especially noticeable on the palms of her hands and soles of her feet. The midwife performed a fetal heart trace (cardiotocogram (CTG)), which was normal, and also took some blood for liver enzymes and bile acids. Chlorpheniramine was prescribed for the itching and an appointment made to attend the antenatal clinic four days later to see the consultant. The liver function tests showed a very high alanine transaminase (ALT) which was 557 iu/1, and raised bile acids of 52 micromols/1. Further CTG monitoring was organised and an ultrasound scan for fetal growth and wellbeing prior to the clinic appointment. Unfortunately, when the patient attended the hospital four days later for the scan an intrauterine death was confirmed. She had noticed decreased fetal movements for 24 hours prior to the visit. The stillbirth was attributed to 'obstetric cholestasis' and all other investigations were normal. The liver function reverted to normal after delivery.