Sudden Intrauterine Fetal Death as a Fetal Complication Due to Intrahepatic Cholestasis of Pregnancy: A Case Report

Abstract

Intrahepatic cholestasis of pregnancy (ICP) is a liver disorder during pregnancy. ICP usually manifests during the second and third trimester of gestation and the diagnosis is based on the clinical symptoms; the presence of pruritus with a deterioration of liver tests, and typically elevated serum levels of total bile acids. The symptoms and liver function tests of ICP resolve spontaneously after delivery. ICP is associated with the risk of preterm delivery, respiratory distress syndrome, meconium-stained amniotic fluid and sudden intrauterine fetal death. We report a case of 23-year-old patient who was admitted to our hospital in the 32th week of pregnancy due to decreased fetal movements a month before. The clinical symptoms was pruritus and jaundice, it was appeared a three month before hospitalization. Immunology tests parasitology and virology tests were negative. The patient denied taking any medicines and herbal preparations before and during pregnancy. Total bile acids in the serum were significantly elevated (147 mg/L). Liver enzymes were raised. The abdominal ultrasound revealed a collapsed gallbladder without image of cholelithiasis. Obstetric ultrasound revealed a sudden intauterine fetal death at 23th week of pregnancy. She underwent induction of labour and delivered a death male infant.