Intrahepatic cholestasis of pregnancy: a critical clinical review.

Intrahepatic cholestasis of pregnancy is the most common liver disease of pregnancy. It is characterized by pruitus, elevated levels of maternal serum bile salts, and normal or mildly elevated liver enzymes occurring after 30 weeks of pregnancy. The primary risks associated with this condition include preterm delivery, meconium-stained amniotic fluid, and stillbirth. Management of intrahepatic cholestasis of pregnancy utilizes a 2-prong approach of oral medications and comfort measures along with active management close to term. The goal of active management has been to deliver women between 37 and 39 weeks of gestation in order to prevent the risk of stillbirth. Currently, expert opinions vary as to recommendations for fetal surveillance and induction of labor. Controversy exists as to whether there is an increased incidence of stillbirth between 37 and 39 weeks of gestation. This critical clinical review is a comprehensive overview of intrahepatic cholestasis of pregnancy, including background, controversies, and care of the pregnant woman with this condition and how to provide appropriate follow-up care later after delivery.