CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2021; 81(08): 922-939
DOI: 10.1055/a-1386-3912
GebFra Science

Management of Intrahepatic Cholestasis of Pregnancy: Recommendations of the Working Group on Obstetrics and Prenatal Medicine – Section on Maternal Disorders

Article in several languages: English | deutsch
Carsten Hagenbeck
1   Universitätsklinikum Düsseldorf, Frauenklinik, Düsseldorf, Germany
Amr Hamza
2   Universitätsklinikum des Saarlandes, Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Homburg, Germany
3   Kantonsspital Baden AG, Baden, Switzerland
Sven Kehl
4   Frauenklinik, Friedrich Alexander University Erlangen Nuremberg, Faculty of Medicine, Erlangen, Germany
Holger Maul
5   Section of Prenatal Disgnostics and Therapy, Asklepios Klinik Barmbek, Hamburg, Germany
Frank Lammert
6   Klinik für Innere Medizin II, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany
Verena Keitel
7   Universitätsklinikum Düsseldorf, Klinik für Gastroenterologie, Hepatologie und Infektiologie, Düsseldorf, Germany
Matthias C. Hütten
8   Clinique E2 Neonatology, Maastricht Universitair Medisch Centrum+, Maastricht, Netherlands
Ulrich Pecks
9   Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Gynäkologie und Geburtshilfe, Kiel, Germany
› Author Affiliations


Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disease specific to pregnancy. The cardinal symptom of pruritus and a concomitant elevated level of bile acids in the serum and/or alanine aminotransferase (ALT) are suggestive for the diagnosis. Overall, the maternal prognosis is good. The fetal outcome depends on the bile acid level. ICP is associated with increased risks for adverse perinatal outcomes, including preterm delivery, meconium-stained amniotic fluid, and stillbirth. Acute fetal asphyxia and not chronic uteroplacental dysfunction leads to stillbirth. Therefore, predictive fetal monitoring is not possible. While medication with ursodeoxycholic acid (UDCA) improves pruritus, it has not been shown to affect fetal outcome. The indication for induction of labour depends on bile acid levels and gestational age. There is a high risk of recurrence in subsequent pregnancies.

Publication History

Received: 13 January 2021

Accepted after revision: 05 February 2021

Publication Date:
09 August 2021 (online)

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