La cholestase gravidique

Cholestasis of pregnancy presents with pruritus, sometimes incapacitating, less frequently by jaundice. It occurs during the second or third trimester. Its prevalence in France is of the order of 1 per 100 pregnancies. It is slightly more frequent during twin pregnancies. Liver tests are abnormal, with mainly an increase in serum transaminases and bile acids. Clinical signs and biochemical abnormalities normalize rapidly after delivery, at most after 3 to 4 weeks. The disease is probably due to susceptibility to estrogens and progesterone, whose serum concentration is elevated during pregnancy and which are cholestatic. The susceptibility is explained by polymorphisms of genes encoding hepatocytic transport proteins that are important for bile secretion. Besides disturbing pruritus, maternal prognosis is good. Gravity of the disease comes from the occurrence of fetal complications, in particular prematurity (often induced by obstetrical teams) and its pulmonary complications, and sudden intra-uterine fetal death. Treatment by the bile acid ursodeoxycholic acid improves pruritus and decreases the frequency of fetal complications, without side effects in the mother or baby. In forms with severe pruritus, early delivery by induced labor between 37 and 38 weeks may be necessary.