In England, obstetric cholestasis (also referred to as intrahepatic cholestasis of pregnancy) affects 0.7% of pregnancies in multiethnic populations and 1.2–1.5% of women of Indian–Asian or Pakistani–Asian origin. Prevalence is influenced by genetic and environmental factors and varies between populations worldwide. For example, in Chile, 2.4% of all pregnancies are affected, with a 5% prevalence in women of Araucanian–Indian origin. Obstetric cholestasis is a multifactorial condition of pregnancy characterised by pruritus in the absence of a skin rash with abnormal liver function tests (LFTs), neither of which has an alternative cause and both of which resolve after birth. Most authorities accept elevations of any of a wide range of LFTs beyond pregnancy-specific limits. Investigations to exclude other causes of pruritus and of abnormal LFTs should be performed. The clinical importance of obstetric cholestasis lies in the potential fetal risks, which may include spontaneous preterm birth, iatrogenic preterm birth and fetal death. There can also be maternal morbidity in association with the intense pruritus and consequent sleep deprivation.
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