Cholestasis of pregnancy


  • Caused by combination of hormonal, genetic, and environmental factors --> impaired bile flow --> deposition of bile salts in skin and placenta
  • May predispose mothers to vitamin K deficiency and increase risk of preterm delivery, IUFD, and neonatal respiratory distress syndrome[1]

Clinical Features

  • Typically develops in late second and/or 3rd trimester
  • Rapidly resolves after delivery
  • Pruritus, starts and predominates on palms and soles
  • RUQ pain
  • Nausea
  • Jaundice

Differential Diagnosis


Differential diagnosis of hyperbilirubinemia.

Indirect Hyperbilirubinemia

Direct (Conjugated) Hyperbilirubinemia

Hepatocellular damage

Patient will have severely elevated AST/ALT with often normal Alkaline Phosphatase

Pregnancy Related

Transplant Related

Pediatric Related

Additional Differential Diagnosis


Only bilirubin stains the sclera

  • Carotenemia
  • Quinacrine ingestion
  • Dinitrophenol, teryl (explosive chemicals)

Pregnancy-specific pruritus

see also: Rashes of pregnancy

  • Pruritus gravidarum
  • Atopic eruption of pregnancy
  • Polymorphic eruption of pregnancy
  • Pemphigoid gestationis
  • Prurigo of pregnancy
  • Pruritic folliculitis of pregnancy


  • CBC (rule out thrombocytopenia)
  • LFTs
    • Elevated total bile acid concentration
    • Aminotransferases usually <2x upper limit of normal
    • Alk phos and bili may be elevated
    • GGT normal or modestly elevated
    • RUQ US normal, no biliary duct dilation


  • Ursodeoxycholic acid (ursodiol) 300mg TID until delivery
  • OBGYN follow-up


  • Discharge with OBGYN follow-up

See Also

External Links