Simplifying Management of Cholestasis: A Proposal for a Classification System

Abstract

Given the stillbirth risk associated with intrahepatic cholestasis of pregnancy, management to reduce this adverse outcome has primarily involved planned delivery as early as 36 weeks gestation. While earlier planned delivery has decreased the incidence of stillbirth in this population, recently, there have been multiple published retrospective studies to better correlate the association of adverse outcomes with cholestasis severity. Despite these new data, the uptake of individualized management for cholestasis has been varied from provider to provider. In this opinion, we briefly review the current literature and evidence regarding cholestasis and adverse outcomes and propose a cholestasis classification system with subsequent algorithms for management.

Key Points

• Recently, multiple studies have further characterized adverse outcomes with cholestasis.

• Incorporation of severity-associated management into clinical practice is variable.

• A cholestasis classification system will simplify and streamline management.

Keywords

bile acids - cholestasis - delivery timing - stillbirth

Publication History

Received: 20 November 2024

Accepted: 03 December 2024

Accepted Manuscript online:
04 December 2024

Article published online:
24 December 2024

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