Simplifying Management of Cholestasis: A Proposal for a Classification System

Minhazur Sarker; Gladys A. Ramos; Lauren Ferrara; Cynthia Gyamfi-Bannerman

doi:10.1055/a-2495-3553

American Journal of Perinatology, Table of Contents

Am J Perinatol
DOI: 10.1055/a-2495-3553

Clinical Opinion

Simplifying Management of Cholestasis: A Proposal for a Classification System

Minhazur Sarker

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, California

,

Gladys A. Ramos

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, California

,

Lauren Ferrara

²Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, New York

,

Cynthia Gyamfi-Bannerman

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, California

› Author Affiliations

Abstract

Given the stillbirth risk associated with intrahepatic cholestasis of pregnancy, management to reduce this adverse outcome has primarily involved planned delivery as early as 36 weeks gestation. While earlier planned delivery has decreased the incidence of stillbirth in this population, recently, there have been multiple published retrospective studies to better correlate the association of adverse outcomes with cholestasis severity. Despite these new data, the uptake of individualized management for cholestasis has been varied from provider to provider. In this opinion, we briefly review the current literature and evidence regarding cholestasis and adverse outcomes and propose a cholestasis classification system with subsequent algorithms for management.

Key Points

Recently, multiple studies have further characterized adverse outcomes with cholestasis.
Incorporation of severity-associated management into clinical practice is variable.
A cholestasis classification system will simplify and streamline management.

Keywords

bile acids - cholestasis - delivery timing - stillbirth

Full Text

References

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