Published online Nov 10, 2013. doi: 10.5317/wjog.v2.i4.62
Revised: August 29, 2013
Accepted: September 3, 2013
Published online: November 10, 2013
Intrahepatic cholestasis of pregnancy (ICP) is a peculiar disease in middle-late pregnancy with the pathological characteristics of hepatic capillary bile duct silts and is accompanied by clinical presentations of pruritus and bile acid (BA) elevation in serum. Maternal outcomes for patients diagnosed with ICP are usually good. However, fetal outcomes can be devastating with high frequencies of perinatal complications. Patients with ICP generally have an early delivery due to fetal complications. The current hypothesis is that ICP has higher frequencies of fetal complications due to high concentrations of BA which has toxic cellular effects to many organs. In lungs, it destroys the AT-II cells, decreasing phospholipids synthesis leading to the alveolar capillary permeability to increase and pulmonary surfactant to decrease. In heart, cholate can cross into the fetal compartment and causing fetal arrhythmias and decreased contractility. In the nervous system, high BAs can cause nerve cell denaturation and necrosis, mitochondria edema and membrane dissolve. In the placenta, high BA concentration can cause edema of the villous, decrease number of villous, intervillous thickening and balloon formation. In addition, high total BA can result in chorionic vein constriction and impaired fetal adrenal function.
Core tip: Fetal outcomes for patients diagnosed with intrahepatic cholestasis of pregnancy can be devastating with serious complications. Advances in our understanding of the reasons that can cause severe fetal complications, such as sudden fetal death, slowed fetal lung maturity, perinatal nervous system injury, distress, and neonatal asphyxia, will provide some hints towards the basic etiology of this disorder. We look forward to a time that early diagnosis will be made and laboratory tests will be carried out to monitor these fetal conditions. I would suggest that more attention should be paid to the fetus which contributes to improve fetal outcomes.