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Case Report
Intrahepatic cholestasis in pregnancy: Increased surveillance and the role of bile acids in a patient with history of fetal demise
1 School of Medicine, Universidad Autonoma de Guadalajara, Phoenix, Arizona, USA
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Noah Ryan Begley
School of Medicine, Universidad Autonoma de Guadalajara, 12745 W Bloomfield Rd, El Mirage, AZ 85335,
USA
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Article ID: 100102Z08NB2022
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Begley NR, Beltran AF. Intrahepatic cholestasis in pregnancy: Increased surveillance and the role of bile acids in a patient with history of fetal demise. J Case Rep Images Obstet Gynecol 2022;8:100102Z08NB2022.ABSTRACT
Intrahepatic cholestasis of pregnancy (ICP) is a known risk for fetal demise and premature delivery and presents in up to one-third of all pregnancies. Cases traditionally present with pruritus, elevated bile acids, and/or elevated liver enzymes. We describe the case of a third-trimester patient with history of fetal demise and ICP that would have gone unnoticed based on laboratory reporting and symptomatic delay. The patient’s symptoms presented weeks after bile acid findings and when tested again were sub-diagnostic. The patient declined pharmacological intervention and opted to induce labor during her 37th week where she delivered a healthy term child. The diagnosis was further complicated when the types and thresholds for bile acids varied between facilities. Our case highlights the importance timely assessment of itching in pregnant patients and the need to assess lab values objectively in the context of clinical features.
Keywords: Antenatal care, Cholestasis of pregnancy, Liver enzymes, Pruritus, Serum bile acids
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Acknowledgments
Thank you to Doctor David M. Greenspan, MD for his mentorship, guidance, and passion for obstetrics that inspired this collaboration. Thank you to Doctor Lourdes Gonzalez, MD for her support and encouragement to complete this review.
Author ContributionsNoah Ryan Begley - Substantial contributions to conception and design, Acquisition of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Abdalyz Frias Beltran - Substantial contributions to conception and design, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2022 Noah Ryan Begley 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.
