Zwangerschapscholestase

- Intrahepatic cholestasis of pregnancy occurs mainly in the final months of pregnancy, and is characterised by pruritus. Foetal morbidity and mortality are increased.

- The disorder is probably caused by a genetic defect in hormonal metabolism which becomes manifest during the altered hormonal balance in pregnancy.

- The total serum bile acid concentration is the diagnostic hallmark of the disease. Other routine laboratory tests have a low sensitivity and specificity.

- An active obstetric management with routine foetal assessments, caesarean section if the foetal condition worsens, and termination of the pregnancy at 37-38 weeks, probably prevents a large proportion of complications.

- Ursodeoxycholic acid treatment should be considered especially in patients with severe pruritus or complications in previous pregnancies.