Obstetric cholestasis

Obstetric cholestasis (or intrahepatic cholestasis of pregnancy) remains widely disregarded as an important clinical problem, with many obstetricians still considering its main symptom, pruritus, a natural association of pregnancy. Obstetric cholestasis is associated with cholesterol gallstones. It may be extremely stressful for the mother but also carries risks for the baby. Clinical studies clearly show that when obstetric cholestasis complicates pregnancies it may lead to premature births in up to 60%, fetal distress in up to 33%, and intrauterine death in up to 2% of patients.1 The cause of fetal death is acute anoxia.2 The incidence of obstetric cholestasis varies from 0.1% to 1.5% of pregnancies in Europe and 9.2%-15.6% in South American countries such as Bolivia or Chile. It is particularly high in the native Araucanian population in Chile, where the proportion of affected pregnancies reaches nearly 28%.3 The low quoted incidence of obstetric cholestasis in Europe may reflect an underestimation of the problem, and growing awareness of the condition will probably increase the numbers. For example, early studies from North America, published in 1962, showed its incidence to be less than 0.1%, whereas a study published 17 years later estimated the incidence to be around …