Colestasis en el embarazo

Abstract

The biochemical alterations can be due to multiple causes, being the liver diseases of pregnancy the most frequent, the present study deals with the intrahepatic cholestasis that is a reversible form of cholestasis, of multifactorial cause that occurs between the second and third trimesters of pregnancy, is characterized by the difficulty for the synthesis of the components of bile to the bile canaliculum; clinically this pathology presents with pruritus which is the dominant sign with predominance in palms and plants which then generalizes to the trunk and face, worsening during the night, causing insomnia; Biochemically it is characterized by the increase of bile acids; its diagnosis is clinical and by exclusion of other pathologies, most complications occur when bile acid levels exceed 40 u mol / 1. The primary objective of treatment is to reduce maternal symptoms, improve biochemical parameters, optimize the viability of the fetus; the first choice treatment is ursodeoxycholic acid in doses of 10-15 mg / kg and is well tolerated and safe for both the mother and the fetus; although the maternal prognosis is excellent; Fetal risk includes preterm birth, meconium amniotic fluid, low APGAR, fetal distress, and in utero death. In the present clinical case, a patient with intrahepatic cholestasis was studied during the third trimester with classic clinical presentation, slight elevation of biochemical parameters, despite a favorable patient evolution, fetal death occurs, more frequent complication in this pathology.