Gorkem ARICA, Ismail YILMAZ, Dilek BULDUM, Adil BARUT, Riza MADAZLI
Gynecology Obstetrics & Reproductive Medicine - 2026;32(1):55-59
This narrative review synthesizes current literature on the pathogenesis and management of Intrahepatic Cholestasis of Pregnancy (ICP). ICP is a multifactorial liver disorder. It is characterized by intense pruritus and elevated serum bile acids (SBA) or liver enzyme levels. These symptoms typically emerge in the second or third trimester and resolve postpartum. The etiology involves a complex inter-play of genetic, hormonal (e.g., elevated estrogen and progesterone), and environmental factors. This is supported by varied global prevalence (9.2-15.6% in South America versus 0.1-0.5% in Europe) and high recurrence rates (45-90%). Diagnosis requires excluding other hepatobiliary diseases. Pruritus must be present with a random peak SBA concentration of at least 10 mumol/L (or 19 mumol/L, depending on the guideline used). Ursodeoxycholic acid (UDCA) at 10-20mg/kg/day is the first-line treatment. It reduces maternal symptoms and transaminase levels, though its effect on stillbirth is debated. Vitamin K supplementation is advised for a prolonged prothrombin time. Antenatal surveillance includes monitoring liver function and SBA every 1-2 weeks. Fetal monitoring, though necessary, has limited predictive value for sudden fetal death. The risk of stillbirth strongly correlates with SBA levels (3.44% for >= 100mumol/L). Management focuses on risk-stratified delivery timing. If SBA is >= 100 mumol/L, delivery should occur at 35-37 weeks. An SBA between 40 and 99 mumol/L suggests delivery at 37 weeks. If SBA is < 40 mumol/L, pregnancy may continue to 39 weeks. Postpartum, SBA, and liver function should be reassessed at 6-8 weeks.
