Plasmapheresis in management of severe cholestasis of pregnancy

Introduction: Cholestasis of pregnancy usually presents with pruritus in the third trimester and it has good maternal prognosis. However, severe cholestasis can have a significant impact on the fetus leading to intrauterine death. Case Report: A 28-year-old female had severe cholestasis of pregnancy in first pregnancy, in second she developed pruritus and cholestatic liver function tests at 17 weeks gestation. Despite treatment with ursodeoxycholic acid and rifampicin, her liver function tests and bile acids increased significantly raising concerns about viability of pregnancy. Plasmapheresis, never previously used in the UK, was commenced with good response to treatment. Conclusion: In this report, we summarize the successful use of plasmapheresis to control bile acids and prolong pregnancy. Treatment with plasmapheresis should be considered for intrahepatic cholestasis of pregnancy (IPC) that is refractory to traditional therapies. Beata Polewiczowska1, Nishant Gautam1, Julie Wessels2, Alison Brind3 Affiliations: 1Gastroenterology Registrar, Royal Stoke University Hospital, Gastroenterology, Stoke on Trent, UK; 2Nephrology Consultant Royal Stoke University Hospital, Renal Medicine, Stoke on Trent, UK; 3Hepatology Consultant, Royal Stoke University Hospital, Gastroenterology and Hepatology, Stoke on Trent, UK. Corresponding Author: Dr. Beata Polewiczowska, Gastroenterology Registrar, Department of Gastroenterology, Royal Stoke University Hospital, Newcastle Road, Stoke on Trent, Staffordshire ST4 6QG, Private address 19A Western Crescent, Banbury, Oxfordshire, OX16 9BX, UK; Email: [email protected] Received: 29 November 2015 Accepted: 24 December 2015 Published: 11 March 2016