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Abstract

Intrahepatic cholestasis of pregnancy is a complication
in 0.2–2% of pregnancies1 causing pruritis and
increased serum bile acids, liver transaminases, and,
occasionally, bilirubin. It is a multifactorial condition.
The onset of symptoms is most common in the third
trimester, but can be earlier in pregnancy.
It is characterized by pruritus in the absence of a primary
skin condition, with abnormal maternal bile acid
concentrations. Intrahepatic cholestasis of pregnancy
causes minimal risk to the mother except for itching2.
It has been associated with increased risks of fetus due
to prematurity, birth asphyxia, meconium-stained
liquor, fetal distress, and unexplained stillbirths3,4.
Intrahepatic cholestasis has been diagnosed in women
based on self-reported itching with an elevation of
any of a wide range of liver function tests beyond
pregnancy-specific limits.
Serum bile acids may be the only specific laboratory
marker for intrahepatic cholestasis in pregnancy.
Serum bile acid levels are slightly higher in healthy
pregnant women compared to non-pregnant women5.
There is now increasing evidence that most liver
function tests do not reflect the risk of fetal demise
and only increased maternal total serum bile acid
concentration is associated with an increased risk of
stillbirth,

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