Introduction:
Intrahepatic cholestasis of pregnancy (ICP) develops in the late second or third trimester and rapidly resolves postpartum. Previous ICP is a strong risk factor for recurrence in subsequent
pregnancies. Early onset ICP(<28-week gestation) is associated with more severe elevation of bile acids and higher risk of preterm birth, meconium passage and respiratory distress in the
infant.
Case description:
40-year-old female with one previous pregnancy complicated with third trimester ICP, presented with generalized pruritis (predominance of palms and soles worse at night), deranged liver
function tests and raised bile acids 19.1umol/L (1-6) at 11 weeks of gestation. She did not have hyperemesis and her infective screen and ultrasound hepatobiliary system was normal.
Ursodeoxycholic acid 500 mg bd helped control her symptoms. She had regular monitoring of bile acids and liver function through her pregnancy, which gradually normalized by third trimester.
She delivered a healthy baby at 37 weeks' gestation after induction of labour with a birth weight of 3.24 kg. UDCA was stopped postpartum. Her liver function worsened 3 months postpartum
with predominant cholestatic picture and mild transaminitis possibly due to herbal medication use. Anti-smooth muscle antibody was 40 (normal <20 titre). She is asymptomatic and on follow
up with gastroenterologist.
Conclusion:
Reports of first trimester ICP have been linked to genetic predisposition, Invitro fertilization or multiple gestations. One must consider genetic predisposition and undiagnosed liver disorders
Preterm labour seems to be independently linked to early onset ICP regardless of bile acid levels.