Obstetric cholestasis: modern recommendations for diagnosis, treatment, management of pregnancy and childbirth

Abstract

The article is devoted to the most common liver disease which is associated with pregnancy – obstetric cholestasis. The frequency of this pathology among all liver disorders in pregnant women is almost 27%, second only to viral hepatitis. On average, it is diagnosed in 2–4 cases per 1000 pregnancies. A characteristic feature of obstetric cholestasis is the tendency to the recurrent course in future pregnancies, which is observed in 60–70% of next pregnancies. This disorder usually manifests itself in the II or III trimester of pregnancy. The links of pathogenesis and differential diagnosis of obstetric cholestasis are briefly described in the article, the main attention is paid to laboratory diagnostic markers of the disease, among which the concentration of bile acids in the blood of a pregnant woman is the most important. An increase concentration of bile acids ≥10 μmol/L is currently a main diagnostic criterion for obstetric cholestasis and can stimulate the release of prostaglandins, increase the sensitivity of the myometrium to oxytocin and its contractility, which in 12–44% of cases causes premature birth. Modern recommendations on pregnancy management and childbirth tactics for women with obstetric cholestasis and the main methods of treatment are also presented in the article. Today, for the treatment of cholestatic hepatosis in pregnant women, medicines are used that specifically reduce the phenomena of intrahepatic cholestasis – ursodeoxycholic acid and 5-adenosylmethionine, as well as symptomatic treatment – cholestyramine (or other sequestrants of bile acids), H1-histamine receptors blockers, phenobarbital. Today, the most convincing evidence of effectiveness and safety is the data on ursodeoxycholic acid. This article describes a clinical case of pregnancy in a woman with obstetric cholestasis. The woman used combined oral contraceptives for 10 years to prevent an unwanted pregnancy, which obviously caused the future development of this disease during pregnancy. The patient had timely diagnosis and appropriate treatment. At the 37th week of pregnancy, a vaginal delivery took place. A live female child was born, body weight 3000 g, length 48 cm in satisfactory condition.