Cholestasis pregnancy-related

Pregnancy-related cholestasis - category 2 advantages outweigh the... 

The FFPRHC have advised that the lUD method can be advocated in pregnancy-related cholestasis. Both Cu and LNG lUDs can be used [4, 30]. There is concern that a history of COC-related cholestasis may predict subsequent cholestasis with the LNG-IUD however, as the device has a local effect the risk of side-effects is thought to be minimal, and there are no trial data to support or contradict this concern [30]. However, because of the theoretical risk it would be advisable to monitor LFTs after the insertion of a LNG-IUD. 

Intrahepatic cholestasis of pregnancy is a syndrome of unknown etiology characterized by a 100-fold increase in maternal and fetal blood bile salt levels. Bile salts are produced in both the fetal and maternal liver. The fetus transfers the bile salts across the placenta for disposal. When the function of the maternal gallbladder is slowed, bile salts can accumulate in the liver and bloodstream, ultimately resulting in the classical pruritus symptom. It is believed that pregnancy-related hormones may slow bile salt excretion from the gallbladder. 

Ursodeoxycholic acid has been reported to have good efficacy in treating the symptoms of pregnancy-related cholestasis, relieving both pruritus and liver function abnormalities. 

There is very little evidence relating to the role of ROMs in cholestatic liver disease. Serum selenium and glutathione peroxidase activity are decreased in humans with intrahepatic cholestasis of pregnancy (Kauppila et al., 1987). Low levels of vitamin E have been reported in patients with primary biliary cirrhosis, and in children with Alagille s syndrome or biliary atresia (Knight et al., 1986 Jeffrey etal., 1987 Lemonnier etal., 1987 Babin etal., 1988 Kaplan et al., 1988 Sokol etal., 1989). Serum levels of Mn-SOD are increased in patients with all stages of primary biliary cirrhosis compared with patients with other forms of chronic liver disease, although whether this causes or results from the disease process is unclear (Ono etal., 1991). 

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