Abstract:

Intrahepatic cholestasis of pregnancy (ICP) is a liver disease that commonly occurs in the second and third trimesters of pregnancy. Its main manifestations are skin pruritus and elevated serum total bile acid levels, which can lead to adverse pregnancy outcomes. The 2024 guideline of the Society of Obstetricians and Gynaecologists of Canada (SOGC) states that the diagnostic criterion for ICP is non-fasting serum bile acid>19 μmol/L. Serum bile acid levels should be monitored every 2-4 weeks. The timing of delivery is determined individually based on the highest bile acid level during pregnancy and combined with high-risk factors. Ursodeoxycholic acid (UDCA) is the first-line treatment for ICP. The 2022 guideline of the Royal College of Obstetricians and Gynaecologists (RCOG) in the UK stipulates that the diagnostic criterion for ICP is random bile acid≥19 μmol/L accompanied by pruritus without skin lesions, and it does not recommend the routine use of UDCA to reduce the risk of adverse perinatal outcomes in ICP. The 2024 Chinese guideline recommends using a fasting serum bile acid level≥10 μmol/L or a post-meal serum bile acid level≥19 μmol/L as the diagnostic criterion for ICP, and there are also slight differences in the auxiliary examinations, treatment regimens, frequency of prenatal monitoring, and timing of delivery for ICP. By interpreting the 2024 SOGC guideline and conducting a comparative analysis of the three guidelines, we hope to provide more evidence for clinicians in the diagnosis and treatment of ICP.

Key words: Cholestasis, intrahepatic, Pregnancy complications, Bile acid, Diagnosis, Therapy, Clinical governance