Recurrent Intrahepatic Cholestasis of Pregnancy with History of Fetal Demise

Abstract

Intrahepatic cholestasis of pregnancy (ICP) is a rare, potentially fatal liver disorder that occurs in late pregnancy. It is characterized by pruritus, jaundice, and elevated liver enzymes, with spontaneous relief of signs and symptoms after birth. Early detection and treatment are required due to the potential risk of fetal complications, including fetal death. A 30-year-old woman with deeply icteric sclera and skin scratch marks presented to a gastroenterology–hepatology referral clinic. Her liver enzymes, bilirubin levels, and serum bile acid levels were all abnormally high. She also disclosed similar symptoms in her previous pregnancy, which resulted in fetal death at the sixth month. With a presumptive diagnosis of recurrent ICP, the patient was started on ursodeoxycholic acid (UDCA) pills, which significantly improved her pruritus and returned her bile acid levels to normalcy after 2 months of treatment. The delivery was uneventful. We believe that a proper diagnosis combined with UDCA treatment and vigilant obstetric follow-up significantly reduced the patient’s symptoms and prevented a possible intrauterine death.

Keywords:

• pruritis
• jaundice
• prurigo gravidarum
• obstetric cholestasis

Data Sharing

Supporting data for the current case report are available from the corresponding author on reasonable request.

Ethics Approval and Informed Consent

This case report was approved by the Research Ethics Review Committee of the School of Medicine, Addis Ababa University. Prior to data collection, written informed consent was acquired from the patient after the studies had been well explained, and the patient also provided written informed consent for the case details to be published.

Disclosure

The authors report no conflicts of interest in this work.