Intrahepatic cholestasis of pregnancy: Relationship between bile acid levels and maternal and fetal complications

Complicated Pregnancy: Unveiling the Dual Challenge of Acute Cholecystitis and Choledocholithiasis

Gallstone-related complications during pregnancy, though relatively rare, present significant challenges necessitating careful clinical management. Among these complications, the simultaneous occurrence of acute cholecystitis and choledocholithiasis poses a unique dual challenge, especially considering the physiological changes and fetal considerations associated with pregnancy. This case report presents the management of a 27-year-old pregnant woman with acute cholecystitis and choledocholithiasis at 32 weeks of gestation. Diagnostic imaging, including magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP), played crucial roles in the comprehensive evaluation and treatment of the patient. Conservative measures followed by interventional procedures successfully addressed gallstone-related complications while considering maternal and fetal well-being. Collaborative multidisciplinary care involving obstetricians, gastroenterologists, and other specialists was essential in navigating the case's complexity. The successful outcome highlights the importance of individualized management and multidisciplinary collaboration in optimizing maternal and fetal outcomes in pregnant patients with complex gallstone diseases. This case underscores the necessity for continued research and shared clinical experiences to refine the approach to such intricate medical scenarios, ultimately enhancing the quality of care provided to pregnant individuals facing gallstone-related complications.

A Systematic Approach to Pregnancy-Specific Liver Disorders

Consultation for liver disease during pregnancy is challenging for both the hepatologist and gynecologist, as normal physiologic changes during pregnancy can mimic chronic liver disease. Pregnancy-specific liver disorders are leading causes of abnormal liver function tests during pregnancy. Moreover, up to 3% of all pregnant women in developed countries experience liver diseases nonspecific to pregnancy. When severe, pregnancy-specific liver disorders are associated with significant morbidity and mortality for both the mother and the fetus. The main factors that determine maternal prognosis are the type of liver disease; degree of impaired synthetic, metabolic, and excretory liver function; and timing of delivery. This article focuses on a systematic approach to diagnosing and managing pregnancy-specific liver disorders, which includes understanding normal findings in pregnancy, excluding liver diseases nonspecific to pregnancy, factoring in trimester status, and using clinical clues to make a diagnosis and provide treatment in a timely fashion.

Ursodeoxycholic acid improves pregnancy outcome in patients with intrahepatic cholestasis during pregnancy: A protocol for systematic review and meta-analysis

BACKGROUND

Intrahepatic cholestasis of pregnancy (ICP) is a common complication in the third trimester of pregnancy, which may result in premature delivery, fetal distress, stillbirth, and other adverse pregnancy outcomes. Ursodeoxycholic acid (UDCA) is a first-line treatment for ICP and has been controversial in improving adverse pregnancy outcomes. The purpose of this protocol is to systematically evaluate the effect of UDCA on pregnancy outcomes in patients with intrahepatic cholestasis during pregnancy.

METHODS

To search the databases PubMed, Embase, Web of Science, the Cochrane Library, CNKI, WanFang, VIP, CBMDIsc by computer, then to include randomized controlled clinical studies on UDCA for treatment of intrahepatic cholestasis during pregnancy from the establishment of the database to October 1, 2020. Two researchers independently extract and evaluate the data of the included studies, and meta-analysis is conducted on the included literatures using RevMan5.3 software.

RESULTS

This protocol evaluates the outcome of UDCA in improving ICP by incidence of postpartum hemorrhage in pregnant women preterm birth rates meconium contamination rate in amniotic fluid incidence of fetal distress scale of newborns scoring <7 in 5-min Apgar incidence of neonatal admission to neonatal intensive care unit.

CONCLUSION

This protocol will provide an evidence-based basis for clinical use of UDCA in the treatment of intrahepatic cholestasis during pregnancy.

ETHICS AND DISSEMINATION

Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval was not required. The results may be published in a peer-reviewed journal or disseminated at relevant conferences.

OSF REGISTRATION NUMBER

DOI 10.17605 / OSF.IO / BE67H.