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Obstetric Cholestasis (Green-top Guideline No. 43)

Published: 19/05/2011

This is the second edition of this guideline. The first edition was published in 2006 under the same title.

The third edition of this guideline is currently in development.

Update December 2014: New evidence and guidance in this field were reviewed in 2014 and it was decided that revision of this guideline would be deferred to a later date. The version available on the website and app remain valid.

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. 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.

This guideline summarises the evidence for the fetal risks associated with obstetric cholestasis and provides guidance on the different management choices and the options available for its treatment.The wide range of definitions of obstetric cholestasis and the absence of agreed diagnostic criteria make comparisons of the published literature challenging and limit the ability to provide detailed recommendations for specific aspects of care. Areas of uncertainty are highlighted along with recommendations for future research in this field.