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Intrahepatic cholestasis of pregnancy (ICP), also known as obstetric cholestasis, cholestasis of pregnancy, jaundice of pregnancy, and prurigo gravidarum, [1] is a medical condition in which cholestasis occurs during pregnancy. [2] It typically presents with itching and can lead to complications for both mother and fetus. [2]
The increased occurrence of gallstones during pregnancy is due to inhibition of gallbladder contraction (as result of increased smooth muscle relaxation mediated by progesterone) and reduced biliary transportation of bile (mediated by estrogen) which results in cholestasis of pregnancy. [36]
Gallbladder and biliary-related diseases occurred in about 104 million people (1.6% of people) in 2013 and resulted in 106,000 deaths. [8] [9] Gallstones are more common among women than men and occur more commonly after the age of 40. [2] Gallstones occur more frequently among certain ethnic groups than others. [2]
Cholestasis is a condition where the flow of bile from the liver to the duodenum is impaired. [1] The two basic distinctions are: [1] obstructive type of cholestasis, where there is a mechanical blockage in the duct system that can occur from a gallstone or malignancy, and
During pregnancy when female sex hormones are naturally raised, biliary sludge (particulate material derived from bile that is composed of cholesterol, calcium bilirubinate, and mucin) appears in 5% to 30% of women. Resolution frequently transpires during the post-partum period: sludge disappears in two-thirds; small (<1 cm) gallstones ...
Gallstones are more common in pregnant women due to elevated hormones and cholesterol levels, which block the bile duct and obstruct bilirubin excretion. [11] Besides, preeclampsia and eclampsia, denoted by high blood pressure, are linked to hyperbilirubinemia through damaging highly perfused organs, particularly liver and kidneys. [12]
Gallbladder hepatization, which is biliary sludge filling the entire gallbladder, giving it an echogenicity similar to the liver (seen at left). The patient had a stone in the cystic duct. Biliary sludge is typically diagnosed by CT scan or transabdominal ultrasonography. [1] [2] Endoscopic ultrasonography is another more sensitive option.
It is generally safe for pregnant women to undergo laparoscopic cholecystectomy during any trimester of pregnancy. [8] Early elective surgery is recommended for women with symptomatic gallstones to decrease the risk of spontaneous abortion and pre-term delivery. [ 8 ]