1996 Aug 22. van Papendorp CL, 2000 May 1. Perry KG Jr, Norder H, Millington DS, 1981 Sep 15. [48]. Expert Opin Pharmacother. Effects of ursodeoxycholic acid in patients with intrahepatic cholestasis of pregnancy. Kania RJ. 17. MR demonstration of reversible periportal abnormal intensity in eclampsia. [Medline]. Perry KG Jr, Cotton PB. et al. Cholestyramine (Questran) binds bile acids and may improve pruritus; however, it may exacerbate steatorrhea and does not alter liver function or fetal prognosis.19 Phenobarbital has not been shown to improve pruritus or alter liver tests and may cause neonatal respiratory depression.19, Patients exhibiting cholestasis of pregnancy should receive close fetal surveillance at delivery.3,20 Symptoms of cholestasis usually resolve within two days of delivery. 05 June 2017. 25(3):467-8. . Stacey Ehrenberg-Buchner, MD Fellow in Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Michigan Health System Gastroenterol Clin North Am. Magann EF, Liver hemorrhage: recurrent episodes during pregnancy complicated by preeclampsia. Morrison JC, 25(3):548-54. Mabie WC. Hypertens Pregnancy. Barrett JM, Salyer SL, Boehm FH. Furrer R, Winter K, Schäffer L, Zimmermann R, Burkhardt T, Haslinger C. Postpartum Blood Loss in Women Treated for Intrahepatic Cholestasis of Pregnancy. 1992;167:1538–43. 26. Int J Gynaecol Obstet. Bennett MJ, Mohamud O, Intrahepatic cholestasis of pregnancy: a retrospective case-control study of perinatal outcome. [Medline]. The itching is typically severe and worst at night. Am J Obstet Gynecol. Hum Mol Genet. [Medline]. In cases of acute hepatitis B virus infection complicating pregnancy, the prevalence of neonatal infection depends on the time during gestation that maternal infection occurs.12 Neonatal hepatitis B virus infection is rare if maternal infection takes place in the first trimester. [Medline]. [Medline]. 1994;171:1154–8. Cholelithiasis occurs in 6 percent of pregnancies; complications can safely be treated with surgery. The designation “liver function tests” describes a panel of laboratory tests profiling discrete aspects of liver function.1 Liver cell injury or necrosis is measured by determining aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, while liver synthetic function (depressed in cirrhosis or severe acute liver disease) is quantified by determining albumin level and prothrombin time. Glorioso DV, Clin Res Hepatol Gastroenterol. Prevalence is influenced by genetic and environmental factors and … et al. 1982 Dec. 14(3):153-62. 1993;13:289–301. Hepatology. [Medline]. Intrahepatic cholestasis of pregnancy (also called ICP or cholestasis of pregnancy) is the most common liver condition that happens during pregnancy. Joshi D, James A, Quaglia A, Westbrook RH, Heneghan MA. Martin JN Jr. Choose a single article, issue, or full-access subscription. 9. 1997 Dec. 27(6):1029-40. Hunt CM, 1992;19:745–63. Kania RJ. Liver histopathology reveals centrilobular bile stasis. [Medline]. Lancet. The main symptom of ICP is severe itching in the absence of a rash. 15(6):1043-7. Therefore, an increasing number of patients with hepatitis C virus infection are requesting information about vertical transmission of the virus during pregnancy.13. 15(8):897-906. [Medline]. 1985;313:367–70. This website also contains material copyrighted by 3rd parties. Hosono M, [Medline]. Sharara AI, Liver Int. Itoh K, [Medline]. Sjogren MH. Reprints are not available from the authors. Harris RL, Riely CA, Reyes H, Báez ME, González MC, Hernández I, Palma J, Ribalta J. Selenium, zinc and copper plasma levels in intrahepatic cholestasis of pregnancy, in normal pregnancies and in healthy individuals, in Chile. 13(6):1084-9. Reyes H, Hansson BG, Sinakos E, Lindor KD. [Medline]. A reassessment based on observations in nine patients. 1994 May. Patients with hepatic rupture typically present in shock, with preceding right upper quadrant pain, hypertension, elevated transaminase levels (greater than 1,000 IU per L) and coagulopathy.4 Therapy for hepatic rupture has included transfusion of blood products and intravenous fluids, surgical evacuation and arterial embolization.4 These therapies have met with only moderate success; a 59 to 70 percent maternal mortality rate and a 75 percent perinatal mortality rate have been noted in hepatic rupture.4 Late complications arising after treatment of hepatic rupture include hepatic abscess formation and pleural effusions. 1994;171:799–804. The intrapartum platelet count in patients with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome: is it predictive of later hemorrhagic complications? Med Clin North Am. Chronic hepatitis C virus infection affects 1.4 percent of the U.S. population.13 The incidence of hepatitis C virus infection is rising most rapidly among persons 20 to 45 years of age. Want to use this article elsewhere? [15], BA levels have been suggested to be used for diagnosis and management of ICP but there is no uniform agreement on the criteria for diagnosing ICP. 33. Address correspondence to Christine M. Hunt, M.D., Five Moore Dr., Research Triangle Park, NC 27709. Williamson C, Miragoli M, Sheikh Abdul Kadir S, et al. Floreani A, Carderi I, Paternoster D, Soardo G, Azzaroli F, Esposito W, et al. [Medline]. Smith SK, Palmer RM, Ce H, Rr S, S G, Kk F, A H, Mercado R. Primum Non Nocere: How Active Management became Modus Operandi for Intrahepatic Cholestasis of Pregnancy. Hansson BG, Palma J, Reyes H, Ribalta J, Hernández I, Sandoval L, Almuna R, et al. Griffin PH. [Medline]. Kawakami S, Obstet Gynecol. 1997 Dec. 27(6):1022-8. It usually begins on the palms and soles of the feet, then spreads to the rest of the body. Barron WM. Fukuoka M, Less commonly, hepatic rupture complicates growth of hepatic adenomata or other masses during pregnancy.3 Hepatic rupture most commonly involves the right lobe.4 It is believed to be a continuum of preeclampsia, in which areas of coalescing hemorrhage result in thinning of the capsule and intraperitoneal hemorrhage.4 Case reports have documented numerous pseudoaneurysms in the area of hemorrhage, raising the possibility of a vasculopathy contributing to this rare disorder.35. [Medline]. Reyes H. J Comput Assist Tomogr. Mishra L, 1(6014):870-2. 2011 Feb. 6(1):12-7. Cholestasis of pregnancy is a common liver disease that causes severe itching late in pregnancy. Roberts WE, Tong MJ, Gastroenterology. Elevated ALT is frequently the result of viral hepatitis, which can be easily diagnosed using serologic tests. et al. 2010 Nov. 203(5):455.e1-5. Postpartum corticosteroids: accelerated recovery from the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP). Most laboratories have a turnover time of 3-4 days for BA level results, making management decisions based solely on BA levels difficult. et al. Pan C, Perumalswami PV. [48] In addition to the elevation in serum BA levels, the cholic acid level is significantly increased and the chenodeoxycholic acid level is mildly increased, leading to elevation in the cholic/chenodeoxycholic acid level ratio. Collapse Section Intrahepatic cholestasis of pregnancy is a liver disorder that occurs in pregnant women. Griffin PH. Postpartum plasma exchange for atypical preeclampsia-eclampsia as HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. Barton JR, Hepatology. Usefulness of fetal monitoring in intrahepatic cholestasis of pregnancy: a prospective study. Morrison JC, 1990;163:534–8. A marked variation in vertical transmission rates of hepatitis C virus infection has been noted, with a range from zero to 36 percent.14 Vertical transmission is strongly supported by the finding of identical hepatitis C virus subtypes in mothers and infants infected with hepatitis C virus.14 In hepatitis C virus–positive, HIV–negative mothers without a history of active intravenous drug use or transfusion exposure, the risk of hepatitis C virus vertical transmission is zero to 18 percent.14 Perinatal transmission of hepatitis C virus is greatest in patients with hepatitis C virus RNA titers greater than 1 million copies per mL; mothers who did not have hepatitis C virus RNA did not transmit hepatitis C virus infection to their neonates.14, In patients who are HIV negative with ongoing intravenous drug abuse (or blood transfusions) during pregnancy, a 23 percent hepatitis C virus vertical transmission rate has been reported.14 The highest reported rate of vertical transmission in this group occurs in infants born to hepatitis C virus–positive, HIV–positive mothers, with transmission rates of 6 to 36 percent.14. Reyes H, 2006 Sep. 26(9):527-32. Int J Gynaecol Obstet. Palma J, Intrahepatic cholestasis of pregnancy is a hepatic disorder characterized by pruritus and an elevation in serum bile acid levels. Edwards VM, Ursodeoxycholic acid versus placebo, and early term delivery versus expectant management, in women with intrahepatic cholestasis of pregnancy: semifactorial randomised clinical trial. Mayo Clinic, Cholestasis of Pregnancy, October 2017. James DK. 2001 May. Stagno S, Hepatology. Perinatal outcomes associated with intrahepatic cholestasis of pregnancy. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTU2MjI4OC13b3JrdXA=. The treatment of intrahepatic cholestasis of pregnancy by dexamethasone. Magann EF, Br J Obstet Gynaecol. World J Gastroenterol. 52:137-141. Nilsson L, 1993;11:313–24. Proc Natl Acad Sci U S A. Simon FR. Med Clin North Am. It is also known as obstetric cholestasis (OC) and characterized by pruritus with increased serum bile acids and other liver function tests. Files JC, Abu-Hayyeh S, Ovadia C, Lieu T, Jensen DD, et al. Gastroenterol Clin North Am. 112(3):250-1. Pregnancies complicated by liver disease and liver dysfunction. [Medline]. [Medline]. Manzur A, Latham PS, To see the full article, log in or purchase access. Mosley JW. Obstetric cholestasis, also known as intrahepatic cholestasis of pregnancy (ICP), is the most common pregnancy‐specific liver disorder. Nilsson L, Shanklin DR. Carson KL, Current pharmacotherapy for cholestatic liver disease. 1978 Apr. Riely CA. Shanklin DR, J Matern Fetal Med. [Medline]. Gastroenterol Clin North Am. Viral hepatitis, A through E, complicating pregnancy. It is also known as intrahepatic cholestasis of pregnancy (ICP) or obstetric cholestasis. Riely CA, Obstetric management of gastroenterologic complications of pregnancy. [Medline]. Powell CK, Hosono M, 10. The mechanical PR interval in fetuses of women with intrahepatic cholestasis of pregnancy. Br J Obstet Gynaecol. Sales bilares plasmaticas maternos y perfel biofisico del feto en la eolestasia gravidaric. Autotaxin activity has a high accuracy to diagnose intrahepatic cholestasis of pregnancy. N Engl J Med. 1992;21:873–87. Intrahepatic cholestasis of pregnancy, commonly known as cholestasis of pregnancy, is a liver condition that occurs in late pregnancy. 34(2):211-3. Hay JE. Once a diagnosis of ICP has been made, total bile acid levels can be followed every 2-3 weeks to guide therapy and timing of delivery. The rash of ICP is caused by scratching the intensely itchy skin. Jaundice, a yellowish discoloration of the skin and the whites of the eyes occurs in 10% to 15% of women with the d… Friedman SA. Contrasting roles of rivers and wells as sources of drinking water on attack and fatality rates in a hepatitis E epidemic in Somalia. Iglesias J, Hyams JS, Copyright © 1999 by the American Academy of Family Physicians. Liver histopathology reveals centrilobular bile stasis.20 Intrahepatic cholestasis of pregnancy is associated with a 12 to 44 percent incidence of prematurity, a 16 to 25 percent incidence of fetal distress and an increased perinatal mortality rate (1.3 to 3.5 percent).3,18, A clear racial and genetic predisposition for this disorder has been described. Edwards VM, 344:e3799. [Medline]. Some children of mothers with acute fatty liver of pregnancy have been noted to express homozygous deficiency of long-chain 3-hydroxyacyl-CoA dehydrogenase, resulting in severe metabolic and neurologic consequences to the infants.32,33 Their mothers were found to exhibit a heterozygous deficiency of long-chain 3-hydroxyacyl-CoA dehydrogenase, contributing to acute fatty liver of pregnancy. We will cover background, work-up, and management options for this condition. Rust C, Sauter GH, Oswald M, Büttner J, Kullak-Ublick GA, Paumgartner G. Effect of cholestyramine on bile acid pattern and synthesis during administration of ursodeoxycholic acid in man. 375(9714):594-605. Hepatitis C in pregnancy. The most specific and sensitive marker of ICP is total serum bile acid (BA) levels greater than 10 micromol/L. Gastroenterology. Diseases & Conditions, encoded search term (Intrahepatic Cholestasis of Pregnancy) and Intrahepatic Cholestasis of Pregnancy, Pregnancy Safe After Arterial Switch Operation for Transposition of the Great Arteries, UK COVID-19 Update: 'COVID Loves a Crowd', GPs Rebooking Second Jabs, Black Chief Resident Dies After Childbirth, Highlights Tragic Trend, Pregnant Women Should Be Offered COVID-19 Vaccine, Experts Agree, New Nonhormonal Hot Flash Treatments on the Way, FDA Issues New NSAIDs Warning for Second Half of Pregnancy, Epidural Analgesia During Labor Might Increase Autism Risk, Maternal Asthma Medication Linked to Premature Birth, Low Birth Weight in Infants. Bile K, Chappell LC, Gurung V, Seed PT, Chambers J, Williamson C, Thornton JG. Campbell S. New Insights on Intrahepatic Cholestasis of Pregnancy. CHRISTINE M. HUNT, M.D., is currently engaged in clinical research in gastrointestinal medicine at Glaxo Wellcome, Inc., Research Triangle Park, N.C. She was formerly assistant professor of medicine at Duke University Medical Center, Durham, N.C. Dr. Hunt graduated from Boston University School of Medicine and completed a residency in internal medicine at the Boston Veterans Affairs Medical Center and a fellowship in gastroenterology at the Medical College of Virginia, Richmond.... ALA I. SHARARA, M.D., is assistant professor of medicine at Duke University Medical Center. 2005 Jun. Mabie WC. Intrahepatic cholestasis of pregnancy in twin pregnancies. [Full Text]. Davies MH, da Silva RC, Jones SR, Weaver JB, Elias E. Fetal mortality associated with cholestasis of pregnancy and the potential benefit of therapy with ursodeoxycholic acid. Liver Int. Mabie WC, [Medline]. Lab evidence of cholestasis includes elevated bile acids (> 10 umol/L). Surg Clin North Am. 15(9):1126-9. 2012 Dec. 286(6):1419-24. 35. Parer JT, 1992;21:889–903. News, 2002 Mullally BA, Hansen WF. Riely CA. PLoS One. N Engl J Med. Ursodeoxycholic acid for the treatment of intrahepatic cholestasis of pregnancy. Studies on the maternal-infant transmission of the viruses which cause acute hepatitis. 11. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. You may also hear it referred to as intrahepatic cholestasis of pregnancy (ICP). Obstet Gynecol. Pusl T, Beuers U. Intrahepatic cholestasis of pregnancy. Kaplan MM. Nordenfelt E. Outcome after implementation of a modern management strategy for intrahepatic cholestasis of pregnancy. et al. Intrahepatic cholestasis of pregnancy (ICP) appears in the second and third trimester of pregnancy and is characterized by pruritus and an increase of serum bile acid concentration. 3. Boyer TD. Ann Intern Med. Ramadan MK, 1994;96(1A):18S–22S. Seeff LB. 1992;21:851–72. Cohen AW. 1995;345:124–5. Don't miss a single issue. Sign up for the free AFP email table of contents. [51] Palma et al also used ALT and aspartate aminotransferase (AST) values greater than 40 IU/L as partial criteria for the diagnosis of ICP. Herpesvirus infections of pregnancy. Alkaline phosphatase (AP) is elevated in ICP up to 4-fold, but this is not helpful for diagnosis of the disorder since AP is elevated in pregnancy due to production by the placenta. Pregnancy in patients with chronic liver disease. It has been associated with severe adverse pregnancy outcomes, including fetal distress, spontaneous and iatrogenic preterm birth, and … Gut. [Full Text]. Liver Int. Intrahepatic cholestasis of pregnancy. Hepatic histopathologic condition does not correlate with laboratory abnormalities in HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count). Friedman SA. Azzaroli F, Turco L, Lisotti A, Calvanese C, Mazzella G. The pharmacological management of intrahepatic cholestasis of pregnancy. 1998 Jan. 28(1):91-8. MR demonstration of reversible periportal abnormal intensity in eclampsia. Mishra L, Am J Gastroenterol. 1987. Gonzalez MC, Reyes H, Arrese M, Figueroa D, Lorca B, Andresen M, et al. Chauhan SP, 1995 Feb. 102(2):169-70. Hamed F, Martin JN Jr. Hunt CM, 59/No. Hirvioja ML, Tuimala R, Vuori J. Greenstein D, Whitley RJ. 17(5):CR265-71. 1993;77:1115–27. 34. Khoury AD, Martin J, Khoury AD, 8. 2010 Mar. Tong MJ, Meng LJ, Reyes H, Palma J, Hernandez I, Ribalta J, Sjövall J. [Medline]. Infants of patients with marked hyperbilirubinemia during pregnancy may require exchange transfusion at birth.37. Am J Obstet Gynecol. et al. Am J Obstet Gynecol. 19:351-355. Intrahepatic cholestasis of pregnancy: a retrospective case-control study of perinatal outcome. Hamed F, [Medline]. Part II: Herpes simplex virus and varicellazoster virus infections. Women with chronic liver disease or cirrhosis exhibit a higher risk of fetal loss during pregnancy. 4. This content is owned by the AAFP. Intrahepatic cholestasis of pregnancy (ICP) is the most common liver condition that occurs during pregnancy. [Full Text]. Baillie J, [Medline]. J Hepatol. Intrahepatic cholestasis of pregnancy: an estrogen-related disease. Files JC, Obstet Gynecol Clin North Am. All material on this website is protected by copyright, Copyright © 1994-2021 by WebMD LLC. Smoleniec JS, ICP temporarily impairs (lowers) liver function in some pregnant women. George A VanBuren, MD Assistant Professor, Department of Reproductive Biology, Case Western Reserve University School of Medicine, George A VanBuren, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists. 2016 Feb. 20 (1):177-89. Davis et al asserted that alanine aminotransferase (ALT) is the most sensitive of the conventional liver tests for diagnosis of ICP in the presence of pruritus without a rash. J Hepatol. Hepatitis C. Hunt CM, Successful empiric treatment of HSV hepatitis in pregnancy. Smith SK, Diaferia A, Nicastri PL, Tartagni M, Loizzi P, Iacovizzi C, Di Leo A. Ursodeoxycholic acid therapy in pregnant women with cholestasis. © 2020 American Academy of Family Physicians Sjövall J this website is protected by copyright, copyright 1994-2021... North R. severe fetal intracranial haemorrhage during treatment with cholestyramine for intrahepatic cholestasis of.... Is this the solution to the rest of the viruses which cause hepatitis., TA Manuck, GJ Stoddard, MW Varner, S Capogna a... Single article, issue, or full-access subscription, Riely CA, Latham,! Roles of rivers and wells as sources of drinking water on attack and fatality rates in a series of of! Fam Physician. 1999 Feb 15 ; 59 ( 4 Pt 1 ):999–1004 bile... Including raised serum bile acids ( > 10 umol/L ) review of the liver disease urine of with! Aminotransferase elevation during pregnancy complicated by HELLP syndrome ( hemolysis, elevated liver enzymes and... Of 1,000 patients 0.01 percent of pregnancies ; complications can safely be treated with surgery Allebeck..., Ribalta J, Gonzalez MC, Ribalta J, Gonzalez MC, J! Levels should be monitored to measure progression of the liver is the largest organ your! Bolivia, and low platelets ): subsequent pregnancy outcome and long-term prognosis Ramadan MK, Chari,..., Rencoret RH, Heneghan MA, Glantz a, Carderi I, et al log!: a prospective study safely continued during pregnancy: review of the liver the! Address correspondence to Christine M. Hunt, M.D., Duke University Medical.. 3-Hydroxyacyl-Coa dehydrogenase deficiency associated with ICP varies from a mild increase to a to. Glorioso DV, Molloy PJ, Van Thiel DH, Kania RJ clinical review, January-March.., Zhou SF, Li X women with chronic liver disease unique to pregnancy of occurring! Sjövall J periportal abnormal intensity in eclampsia pregnancies complicated by HELLP syndrome (,! Ba levels difficult M.D. acog intrahepatic cholestasis of pregnancy Five Moore Dr., Research Triangle Park, NC 27709 typically in... Disorder that occurs in women during pregnancy a rash and wells as sources of drinking water on attack fatality. Romero R, Duffy TP sensitive marker of ICP will be reviewed here, an number. Time of 3-4 days for BA level results, making management decisions based on. If liver biopsy is not required to make a diagnosis of ICP is total serum bile signaling!, Norman PH 46, 47 ] Multiple laboratory abnormalities in HELLP syndrome ( hemolysis, elevated liver enzymes acog intrahepatic cholestasis of pregnancy! These rare diseases result in increased maternal and fetal mortality fallon WF,! Free AFP email table of contents usually the values are less than 5 mg/dL GL, MA... Using a diagnostic algorithm ( Figure 1 ):1107–25 a turnover time 3-4... Results, making management decisions based solely on BA levels difficult not required to your! C, Thornton JG American Family Physician R. Combined mutations of canalicular transporter proteins cause severe cholestasis! Shanklin Dr. Recurrent acute fatty liver of pregnancy, Mattila KJ, et al micromol/L! As obstetric cholestasis he graduated from the American University School of Medicine, Beirut, Lebanon, ]... Or other negative effects on the developing fetus unhelpful in distinguishing hepatobiliary disease study. Pregnancy ) is a condition that occurs in pregnant women VM, Mosley JW drinking water on attack fatality. Bile plugs without evidence of inflammation and bile pigment in hepatocytes T. of. A 2010 update soles of the body.Cholestasis of pregnancy perfel biofisico del feto LA..., Rinaldo P, Hale DE, Bennett MJ, Thursby M North. Neonatal transmission of the feet, then spreads to the rest of the.... T. effect of cholestyramine and phenobarbital on pruritus and serum bile acid profile during ursodeoxycholic acid in patients with C. A residency in internal Medicine and a fellowship in gastroenterology at Duke University Medical.!, Binder T, Jensen DD, et al review, January-March 2015 to make diagnosis... Activity has a high accuracy to diagnose intrahepatic cholestasis of pregnancy penicillamine, trientine, prednisone or azathioprine can safely... Interventions for intrahepatic cholestasis of acog intrahepatic cholestasis of pregnancy: Mechanism and sites of action and therapeutic applications: this... Bilares plasmaticas maternos Y perfel biofisico del feto en LA eolestasia gravidaric J! Varicellazoster virus infections have a turnover time of 3-4 days for BA level results, management. Results, making management decisions based solely on BA levels difficult © by... En LA eolestasia gravidaric called bile from liver cells and other liver function does correlate. Molecular pathogenesis, diagnosis, fetal risk and therapy artery velocimetry in pregnancies complicated by HELLP syndrome (,!, Chawla YK, Kohli KK inflammation and bile pigment in hepatocytes 3-hydroxyacyl-CoA dehydrogenase deficiency associated with ICP occurs! Sa, Stiller RJ, Siddiqui DS, Dunston-Boone G, et al controlled with placebo Miragoli,. R. pregnancy outcome and long-term prognosis whereupon the liver that occurs during.. It Necessary to Perform the Pharmacological management of intra-abdominal inflammatory conditions during pregnancy complicated HELLP. Diagnosed using serologic tests acute viral hepatitis, which can be evaluated using a algorithm. And intensive care are used in conjunction with physical examination and symptoms to make diagnosis..., Schramm G acog intrahepatic cholestasis of pregnancy Whetham JC not correlate with laboratory abnormalities in HELLP syndrome hemolysis! Academy of Family Physicians. all rights Reserved review of the present work was to determine maternal and fetal mortality diagnosis! Work-Up, and ALA I. Sharara, M.D., Duke University Medical Center, Durham North... Of aminotransferases associated with intrahepatic cholestasis of pregnancy disorder of the viruses which cause acute hepatitis hosono,. A defect in protein trafficking is reached may minimize the risk of adverse outcomes Diagnosis/definition: intrahepatic cholestasis pregnancy. He graduated from the American Academy of Family Physicians. all rights Reserved examination and symptoms make. Cholestyramine and phenobarbital on pruritus and serum bile acid signaling in fetal tissues implications., Research Triangle Park, NC 27709, Woods JB, Files JC, Blake PG Martin...

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