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Case Report
 
Plasmapheresis in management of severe cholestasis of pregnancy
Beata Polewiczowska1, Nishant Gautam1, Julie Wessels2, Alison Brind3
1Gastroenterology Registrar, Royal Stoke University Hospital, Gastroenterology, Stoke on Trent, UK.
2Nephrology Consultant Royal Stoke University Hospital, Renal Medicine, Stoke on Trent, UK.
3Hepatology Consultant, Royal Stoke University Hospital, Gastroenterology and Hepatology, Stoke on Trent, UK.

Article ID: 100011Z08BP2016
doi:10.5348/Z08-2016-11-CR-4

Address correspondence to:
Dr. Beata Polewiczowska
Gastroenterology Registrar, Department of Gastroenterology, Royal Stoke University Hospital
Newcastle Road, Stoke on Trent, Staffordshire ST4 6QG
19A Western Crescent, Banbury, 19A Western Crescent, Banbury, Oxfordshire, OX16 9BX
UK

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How to cite this article:
Polewiczowska B, Gautam N, Wessels J, Brind A. Plasmapheresis in management of severe cholestasis of pregnancy. J Case Rep Images Gynecol Obstet 2016;2:14–19.


Abstract
Introduction: Cholestasis of pregnancy usually presents with pruritus in the third trimester and it has good maternal prognosis. However, severe cholestasis can have a significant impact on the fetus leading to intrauterine death.
Case Report: A 28-year-old female had severe cholestasis of pregnancy in first pregnancy, in second she developed pruritus and cholestatic liver function tests at 17 weeks gestation. Despite treatment with ursodeoxycholic acid and rifampicin, her liver function tests and bile acids increased significantly raising concerns about viability of pregnancy. Plasmapheresis, never previously used in the UK, was commenced with good response to treatment.
Conclusion: In this report, we summarize the successful use of plasmapheresis to control bile acids and prolong pregnancy. Treatment with plasmapheresis should be considered for intrahepatic cholestasis of pregnancy (IPC) that is refractory to traditional therapies.

Keywords: Cholestasis, Intrahepatic Cholestasis of Pregnancy, Plasmapheresis


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Author Contributions
Beata Polewiczowska – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Nishant Gautam – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Julie Wessels – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Alison Brind – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Beata Polewiczowska et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.