Cholestasis of Pregnancy and during Ethinyl Estradiol Administration in the Human and Rat
Cholestasis of pregnancy may be subdivided into two syndromes, pruritus gravidarum and the idiopathic cholestatic jaundice of pregnancy, which represent varying degrees of severity of a common disorder. These syndromes were first differentiated from other causes of itching and jaundice during pregnancy by Svanborg, Thorling, Arfwedson and others (1-5). These syndromes tend to occur in the third trimester of pregnancy. Pruritus gravidarum and the idiopathic cholestatic jaundice of pregnancy tend to occur in the third trimester of pregnancy, although symptoms may appear as early as the first trimester, and are usually characterized by symptoms of generalized pruritus, mild anorexia, nausea and occasional vomiting. In the more severe form, jaundice then appears. The liver may become slightly enlarged and tender, and liver function tests reflect cholestasis, with elevated levels of serum alkaline phosphatase, 5′-nucleotidase, conjugated bilirubin and bromsulphthalein retention, with minimal evidence of hepatocellular necrosis. The major pathological lesion, as seen in the liver biopsy, is intrahepatic cholestasis with centrilobular bile staining of liver cells and canalicular bile plugs, possibly accompanied by minimal parenchymal cell necrosis in areas of bile stasis, but without inflammatory cells or proliferation of mesenchymal cells (see Figure 1).
KeywordsLiver Function Test Biliary Excretion Late Pregnancy Bile Flow Ethinyl Estradiol
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