This study reviewed the literature regarding the diagnosis, antepartum surveillance,
and timing of delivery of pregnancies complicated by intrahepatic cholestasis of pregnancy,
comparing the guidelines published by the Society for Maternal-Fetal Medicine in February
2021 and those published by the Royal College of Obstetricians and Gynaecologists
in the United Kingdom in June 2022. Several key differences exist in the clinical
guidelines between the 2 organizations. With regard to the diagnosis of intrahepatic
cholestasis of pregnancy, the Society for Maternal-Fetal Medicine considers any elevation
in bile acids above the upper limit of normal in the setting of maternal pruritus
diagnostic of intrahepatic cholestasis of pregnancy, whereas the Royal College of
Obstetricians and Gynaecologists requires a pregnancy-specific elevated bile acid
level of ≥19 mmol/L for diagnosis. Regarding the treatment of intrahepatic cholestasis
of pregnancy, the Society for Maternal-Fetal Medicine recommends ursodeoxycholic acid
as the first-line treatment of maternal symptoms. In contrast, the Royal College of
Obstetricians and Gynaecologists specifically recommends against the routine use of
ursodeoxycholic acid for intrahepatic cholestasis of pregnancy because of a lack of
evidence regarding both maternal and fetal benefit. The Society for Maternal-Fetal
Medicine recommends fetal surveillance at a gestational age when abnormal fetal testing
would result in delivery being performed, whereas the Royal College of Obstetricians
and Gynaecologists does not recommend any fetal testing beyond fetal kick count assessment.
The Society for Maternal-Fetal Medicine recommends delivery at 36 to 39 weeks’ gestation
for intrahepatic cholestasis of pregnancy with bile acids <100 mmol/L and delivery
at 36 weeks for bile acid levels >100 mmol/L. The Royal College of Obstetricians and
Gynaecologists recommends serial assessment of bile acids with delivery timing stratified
between 35- and 40-weeks’ gestation according to bile acid levels.
Key words
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Article info
Publication history
Published online: December 08, 2022
Accepted:
December 6,
2022
Received in revised form:
November 16,
2022
Received:
November 10,
2022
Footnotes
The authors report no conflict of interest.
Identification
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