Table of contents
Intrahepatic cholestasis of pregnancy
What's new
Updated 2024 SOGC guidelines for the diagnosis and management of intrahepatic cholestasis of pregnancy.
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of intrahepatic cholestasis of pregnancy are prepared by our editorial team based on guidelines from the Society of Obstetricians and Gynaecologists of Canada (SOGC 2024), the European Association for the Study of the Liver (EASL 2023), the Royal College of Obstetricians and Gynaecologists (RCOG 2022), the American Association for the Study ...
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Screening and diagnosis
Diagnosis: as per SOGC 2024 guidelines, use non-fasting bile acid levels > 19 mcmol/L as the definition for intrahepatic cholestasis.
B
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Differential diagnosis
Diagnostic investigations
History and physical examination: as per RCOG 2022 guidelines, elicit a structured history and perform a physical examination to exclude other causes of itching and liver dysfunction in patients with suspected ICP.
B
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LFTs (baseline)
LFTs (monitoring)
Diagnostic imaging
Screening for HCV infection
Medical management
General principles
As per RCOG 2022 guidelines:
Consider discussing the care of patients with severe, very early, or atypical presentation of ICP with a hepatologist.
C
Review patients with ICP within a consultant-led maternity unit.
B
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UDCA
Antihistamines
Vitamin K
Other agents
Nonpharmacologic interventions
Therapeutic procedures
Patient education
General counseling, management of symptoms
As per RCOG 2022 guidelines:
Counsel patients with ICP that the predominant symptom is itching and it can be severe, may fluctuate, and may markedly affect sleep.
B
Counsel patients that there are no treatments improving pregnancy outcome (or raised bile acid concentrations) and treatments to improve maternal itching are of limited benefit.
B
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General counseling (associated risks)
General counseling (fetal monitoring)
General counseling (mode of birth)
General counseling (neonatal care)
Follow-up and surveillance
Surveillance for preeclampsia and diabetes: as per RCOG 2022 guidelines, obtain BP and urine monitoring and testing for gestational diabetes according to national guidance since patients with ICP have a higher risk of developing preeclampsia and gestational diabetes.
B
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Fetal monitoring
Confirmation of resolution
Subsequent contraception and hormone therapy
Evaluation in future pregnancies