URSO in obstetric cholestasis: not a bear market

See article on page 446 Obstetric cholestasis ( synonym intrahepatic cholestasis of pregnancy) is rapidly emerging from the realms of clinical impressions into a scientific framework. Obstetricians, not least in Britain, have maintained a generally sceptical attitude towards attempts to recognise it as a significant clinical entity. Nevertheless, a consensus is emerging which acknowledges that obstetric cholestasis has major clinical implications for mother and baby.1 The pregnant woman may be driven to distraction by severe pruritus, most severely felt on hands and feet, which leads to regular cold baths and other ineffectual palliation during stressful sleepless nights. The brush off that “itching is of no consequence” and that “everyone itches in pregnancy” merely adds insult to injury. Mothers with a history of obstetric cholestasis have a higher incidence of gallstones. Babies are at increased risk of premature labour with fetal distress and there is a significantly increased risk of stillbirth. Traditional treatments for the pruritus of cholestasis are not very effective, and sequestrants such as cholestyramine exacerbate the tendency to vitamin K deficiency with its attendant risk of perinatal and post-partum haemorrhage. Several recent reports have emerged of the efficacy of ursodeoxycholic acid (URSO), taken orally, in relieving both …