Intrahepatic cholestasis of pregnancy – Diagnosis and management: A consensus statement of the Society of Obstetric Medicine of Australia and New Zealand (<scp>SOMANZ</scp>): Executive summary
William M. Hague, Annette Briley, Leonie Callaway, Marloes Dekker Nitert, Jessica Gehlert, Dorothy Graham, Luke E. Grzeskowiak, Angela Makris, C. Markus, Philippa Middleton, Michael Peek, Antonia Shand, Michael J. Stark, Jason Waugh
Abstract
Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy liver disease, characterised by pruritus and increased total serum bile acids (TSBA), Australian incidence 0.6-0.7%. ICP is diagnosed by non-fasting TSBA ≥19 μmol/L in a pregnant woman with pruritus without rash without a known pre-existing liver disorder. Peak TSBA ≥40 and ≥100 μmol/L identify severe and very severe disease respectively, associated with spontaneous preterm birth when severe, and with stillbirth, when very severe. Benefit-vs-risk for iatrogenic preterm birth in ICP remains uncertain. Ursodeoxycholic acid remains the best pharmacotherapy preterm, improving perinatal outcome and reducing pruritus, although it has not been shown to reduce stillbirth.