The Lancet

Intrahepatic cholestasis of pregnancy is a complication in 0·2–2% of pregnancies,1Williamson C Geenes V Intrahepatic cholestasis of pregnancy.Obstet Gynecol. 2014; 124: 120-133Crossref PubMed Scopus (240) Google Scholar causing pruritis and increased serum bile acids, liver transaminases, and, occasionally, bilirubin. It has been associated with severe adverse pregnancy outcomes, including fetal distress, spontaneous and iatrogenic preterm birth, and stillbirth,1Williamson C Geenes V Intrahepatic cholestasis of pregnancy.Obstet Gynecol. 2014; 124: 120-133Crossref PubMed Scopus (240) Google Scholar for which no effective treatment is yet known.2Gurung V Stokes M Middleton P Milan SJ Hague W Thornton JG Interventions for treating cholestasis in pregnancy.Cochrane Database Syst Rev. 2013; 6 (CD000493.)Google Scholar Ursodeoxycholic acid, which is regularly prescribed, improves biochemical parameters and reduces, although on a limited scale (evidence is conflicting), pruritis.3Chappell LC Gurung V Seed PT Chambers J Williamson C Thornton JG Ursodeoxycholic acid versus placebo, and early term delivery versus expectant management, in women with intrahepatic cholestasis of pregnancy: semifactorial randomised clinical trial.BMJ. 2012; 344: e3799-e3899Crossref PubMed Scopus (123) Google Scholar Antenatal fetal monitoring strategies have not proven effective, resulting in substantial variation in the timing of delivery due to attempts to balance risks of stillbirth against increasingly understood neonatal and childhood complications from late preterm and early term delivery.4Chan E Quigley MA School performance at age 7 years in late preterm and early term birth: a cohort study.Arch Dis Child Fetal Neonatal Ed. 2014; 99: F451-F457Crossref PubMed Scopus (85) Google Scholar, 5Rabie NZ Bird TM Magann EF Hall RW McKelvey SS ADHD and developmental speech/language disorders in late preterm, early term and term infants.J Perinatol. 2015; 35: 660-664Crossref PubMed Scopus (31) Google Scholar This problem is reflected in the scarci...

Management of intrahepatic cholestasis in pregnancy