Cholestasis of pregnancy is associated with increased fetal morbidity and mortality and should be treated actively. The significance attached to
pruritus in pregnancy is often minimal, but it is a cardinal symptom of
cholestasis of pregnancy, which may have no other clinical features. Eight women with previous
cholestasis of pregnancy were referred to The Liver Unit within a 12 month period for advice concerning future pregnancies. Thirteen pregnancies had been affected by
cholestasis of pregnancy and 12 had been treated expectantly with resultant perinatal morbidity or mortality in 11 (one normal delivery), including; eight
stillbirths, two premature deliveries with
fetal distress (one died in perinatal period), and an emergency
caesarean section for
fetal distress. The other pregnancy was treated actively and delivery was uncomplicated. Subsequently, three of these cases with recurrent
cholestasis of pregnancy were referred while pregnant. In each,
cholestasis developed with severe
pruritus, gross increase of serum
bile acids, and deranged liver tests. Each was treated with the choleretic agent
ursodeoxycholic acid, with rapid clinical improvement and resolution of deranged biochemistry. In conclusion,
cholestasis of pregnancy continues to be treated expectantly despite its association with increased morbidity and mortality and evidence suggesting improved prognosis with active treatment and the potential of reducing the associated perinatal mortality. In an uncontrolled series of three patients with
cholestasis of pregnancy,
ursodeoxycholic acid seemed to provide safe and effective
therapy.