Sarker Minhazur, Ramos Gladys A, Ferrara Lauren, Gyamfi-Bannerman Cynthia
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, California.
Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, New York.
Am J Perinatol. 2025 Jul;42(9):1229-1234. doi: 10.1055/a-2495-3553. Epub 2024 Dec 4.
Given the stillbirth risk associated with intrahepatic cholestasis of pregnancy, management to reduce this adverse outcome has primarily involved planned delivery as early as 36 weeks gestation. While earlier planned delivery has decreased the incidence of stillbirth in this population, recently, there have been multiple published retrospective studies to better correlate the association of adverse outcomes with cholestasis severity. Despite these new data, the uptake of individualized management for cholestasis has been varied from provider to provider. In this opinion, we briefly review the current literature and evidence regarding cholestasis and adverse outcomes and propose a cholestasis classification system with subsequent algorithms for management. · Recently, multiple studies have further characterized adverse outcomes with cholestasis.. · Incorporation of severity-associated management into clinical practice is variable.. · A cholestasis classification system will simplify and streamline management..
鉴于妊娠肝内胆汁淤积症与死产风险相关，降低这一不良结局的管理措施主要包括在妊娠36周时尽早计划分娩。虽然早期计划分娩降低了该人群的死产发生率，但最近有多篇发表的回顾性研究，以更好地关联不良结局与胆汁淤积严重程度。尽管有这些新数据，但胆汁淤积个体化管理的采用情况因提供者而异。在本观点中，我们简要回顾了关于胆汁淤积和不良结局的当前文献和证据，并提出了一种胆汁淤积分类系统及后续管理算法。· 最近，多项研究进一步描述了胆汁淤积的不良结局。· 将与严重程度相关的管理纳入临床实践的情况各不相同。· 胆汁淤积分类系统将简化和优化管理。
