Maya QJJ, Zúñiga LDS, Maya QJL

Language: Spanish
References: 41
Page: 17-22
PDF size: 72.47 Kb.

ABSTRACT

The intrahepatic cholestasis of pregnancy is a reversible form of cholestasis which occurs during the second and third trimesters. It is characterized by generalized pruritus prevailing in palms and soles accompanied by an elevation in serum levels of bile acids. It does not involves maternal risk, however there is an increased risk of adverse fetal outcomes, mainly preterm birth, amniotic meconium staining and death in utero. Although the ursodeoxycholic acid has proven effective, it has not achieved the decrease of these outcomes and is nor there an ideal method of fetal monitoring for these cases. The purpose of this article is a review of the literature and case report of a patient of 32 years with a history of two fetal deaths of unknown etiology. During the last 30.2 weeks of gestation she presented pruritus in palms and soles accompanied by discrete generalized jaundice. It was suspected intrahepatic cholestasis of pregnancy by clinical manifestations and figures of elevated serum bile acids.

REFERENCES

1. Bacq Y. Intrahepatic cholestasis of pregnancy. Clin Liver Dis 1999; 3: 1.

2. Reyes H, Gonzalez MC, Ribalta J et al. Prevalence of intrahepatic cholestasis of pregnancy in Chile. Ann Intern Med 1978; 88: 487-493.

3. Lammert F, Marschall HU, Glantz A, Matern S. Intrahepatic cholestasis of pregnancy: molecular pathogenesis, diagnosis and management. J Hepatol 2000; 33: 1012-1021.

4. Pathak B, Sheibani L, Lee R. Cholestasis of pregnancy. Obstet Gynecol Clin North Am 2010; 37: 269-282.

5. de Vree JM, Jacquemin E, Sturm E et al. Mutations in the MDR3 gene cause progressive familial intrahepatic cholestasis. Proc Natl Acad Sci USA 1998; 95: 282-287.

6. Jacquemin E, Cresteil D, Manouvrier S et al. Heterozygous non-sense mutation of the MDR3 gene in familial intrahepatic cholestasis of pregnancy. Lancet 1999; 353: 210-211.

7. Keitel V, Vogt C, Häussinger D, Kubitz R. Combined mutations of canalicular transporter proteins cause severe intrahepatic cholestasis of pregnancy. Gastroenterology 2006; 131: 624-629.

8. Van Mil SW, Milona A, Dixon PH et al. Functional variants of the central bile acid sensor FXR identified in intrahepatic cholestasis of pregnancy. Gastroenterology 2007; 133: 507-516.

9. Sookoian S, Castaño G, Burgueño A et al. Association of the multidrug-resistance-associated protein gene (ABCC2) variants with intrahepatic cholestasis of pregnancy. J Hepatol 2008; 48: 125-132.

10. Reyes H, Simon FR. Intrahepatic cholestasis of pregnancy: an estrogen-related disease. Semin Liver Dis 1993; 13: 289-301.

11. Gonzalez MC, Reyes H, Arrese M et al. Intrahepatic cholestasis of pregnancy in twin pregnancies. J Hepatol 1989; 9: 84-90.

12. Meng LJ, Reyes H, Palma J et al. Effects of ursodeoxycholic acid on conjugated bile acids and progesterone metabolites in serum and urine of patients with intrahepatic cholestasis of pregnancy. J Hepatol 1997; 27: 1029-1040.

13. Wånggren K, Sparre LS, Wramsby H. Severe jaundice in early IVF pregnancy. Eur J Obstet Gynecol Reprod Biol 2004; 112: 228-229.

14. Arrese M, Macias RI, Briz O et al. Molecular pathogenesis of intrahepatic cholestasis of pregnancy. Expert Rev Mol Med 2008; 10: e9.

15. Saleh MM, Abdo KR. Intrahepatic cholestasis of pregnancy: review of the literature and evaluation of current evidence. J Womens Health (Larchmt) 2007; 16: 833-841.

16. Kenyon AP, Piercy CN, Girling J et al. Obstetric cholestasis, outcome with active management: a series of 70 cases. BJOG 2002; 109: 282-288.

17. Mays JK. The active management of intrahepatic cholestasis of pregnancy. Curr Opin Gynecol Obstet 2010; 22: 100-103.

18. Bacq Y, Sapey T, Bréchot MC et al. Intrahepatic cholestasis of pregnancy: a French prospective study. Hepatology 1997; 26: 358-364.

19. Heikkinen J, Mäentausta O, Ylöstalo P, Jänne O. Changes in serum bile acid concentrations during normal pregnancy, in patients with intrahepatic cholestasis of pregnancy and in pregnant women with itching. Br J Obstet Gynaecol 1981; 88: 240-245.

20. Lunzer M, Barnes P, Byth K, O’Halloran M. Serum bile acid concentrations during pregnancy and their relationship to obstetric cholestasis. Gastroenterology 1986; 91: 825-829.

21. Brites D, Rodrigues CM, Oliveira N et al. Correction of maternal serum bile acid profile during ursodeoxycholic acid therapy in cholestasis of pregnancy. J Hepatol 1998; 28: 91-98.

22. Vanjak D, Moreau R, Roche-Sicot J et al. Intrahepatic cholestasis of pregnancy and acute fatty liver of pregnancy. An unusual but favorable association? Gastroenterology 1991; 100: 1123-1125.

23. Rolfes DB, Ishak KG. Liver disease in pregnancy. Histopathology 1986; 10: 555-570.

24. Palma J, Reyes H, Ribalta J et al. Ursodeoxycholic acid in the treatment of cholestasis of pregnancy: a randomized, double-blind study controlled with placebo. J Hepatol 1997; 27: 1022-1028.

25. Kondrackiene J, Beuers U, Kupcinskas L. Efficacy and safety of ursodeoxycholic acid versus cholestyramine in intrahepatic cholestasis of pregnancy. Gastroenterology 2005; 129: 894-901.

26. Ribalta J, Reyes H, Gonzalez MC et al. S-adenosyl-L-methionine in the treatment of patients with intrahepatic cholestasis of pregnancy: a randomized, double-blind, placebo-controlled study with negative results. Hepatology 1991; 13: 1084-1089.

27. Frezza M, Pozzato G, Chiesa L et al. Reversal of intrahepatic cholestasis of pregnancy in women after high dose S-adenosyl-L-methionine administration. Hepatology 1984; 4: 274-278.

28. Floreani A, Paternoster D, Melis A, Grella PV. S-adenosylmethionine versus ursodeoxycholic acid in the treatment of intrahepatic cholestasis of pregnancy: preliminary results of a controlled trial. Eur J Obstet Gynecol Reprod Biol 1996; 67: 109-113.

29. Roncaglia N, Locatelli A, Arreghini A et al. A randomized controlled trial of ursodeoxycholic acid and S-adenosyl-l-methionine in the treatment of gestational cholestasis. BJOG 2004; 111: 17-21.

30. Hirvioja ML, Kivinen S. Inheritance of intrahepatic cholestasis of pregnancy in one kindred. Clin Genet 1993; 43: 315-317.

31. Ropponen A, Sund R, Riikonen S et al. Intrahepatic cholestasis of pregnancy as an indicator of liver and biliary diseases: a population-based study. Hepatology 2006; 43: 723-728.

32. Centers for Disease Control and Prevention (CDC). U. S. Medical Eligibility Criteria for Contraceptive Use, 2010: Adapted from the World Health Organization Medical Eligibility Criteria for Contraceptive Use, 4th ed. MMWR Recomm Rep 2010: 59(RR-4): 1-86.

33. Zecca E, De Luca D, Marras M et al. Intrahepatic cholestasis of pregnancy and neonatal respiratory distress syndrome. Pediatrics 2006; 117: 1669-1672.

34. Williamson C, Hems LM, Goulis DG et al. Clinical outcome in a series of cases of obstetric cholestasis identified via a patient support group. BJOG 2004; 111: 676-681.

35. Fisk NM, Storey GN. Fetal outcome in obstetric cholestasis. Br J Obstet Gynaecol 1988; 95: 1137-1143.

36. Sepúlveda WH, González C, Cruz MA, Rudolph MI. Vasoconstrictive effect of bile acids on isolated human placental chorionic veins. Eur J Obstet Gynecol Reprod Biol 1991; 42: 211-215.

37. Rioseco AJ, Ivankovic MB, Manzur A et al. Intrahepatic cholestasis of pregnancy: a retrospective case-control study of perinatal outcome. Am J Obstet Gynecol 1994; 170: 890-895.

38. Alsulyman OM, Ouzounian JG, Ames-Castro M, Goodwin TM. Intrahepatic cholestasis of pregnancy: perinatal outcome associated with expectant management. Am J Obstet Gynecol 1996; 175: 957-960.

39. Oztekin D, Aydal I, Oztekin O et al. Predicting fetal asphyxia in intrahepatic cholestasis of pregnancy. Arch Gynecol Obstet 2009; 280: 975-979.

40. Ambros-Rudolph CM, Glatz M, Trauner M et al. The importance of serum bile acid level analysis and treatment with ursodeoxycholic acid in intrahepatic cholestasis of pregnancy: a case series from central Europe. Arch Dermatol 2007; 143: 757-762.

41. Roncaglia N, Arreghini A, Locatelli A et al. Obstetric cholestasis: outcome with active management. Eur J Obstet Gynecol Reprod Biol 2002; 100: 167-170.