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Case Reports
. 2018 Sep;132(3):678-681.
doi: 10.1097/AOG.0000000000002794.

Adjuvant Use of Rifampin for Refractory Intrahepatic Cholestasis of Pregnancy

James Liu  1 , Amanda M Murray, Erin B Mankus, Kayla E Ireland, Ometeotl M Acosta, Patrick S Ramsey
Affiliations
Case Reports

Adjuvant Use of Rifampin for Refractory Intrahepatic Cholestasis of Pregnancy

James Liu et al. Obstet Gynecol. 2018 Sep.

Abstract

Background: Intrahepatic cholestasis of pregnancy is an incompletely understood disease that poses significant fetal risks, including stillbirth. Treatment of intrahepatic cholestasis of pregnancy is aimed at relieving maternal symptoms and improving fetal outcomes.

Case: A 21-year-old gravid woman, 3 para 0111, presented at 27 2/7 weeks of gestation with severe intrahepatic cholestasis of pregnancy. Her clinical course was refractory to first-line therapy with ursodiol, and she was started on rifampin with rapid improvement of symptoms and transaminitis. Despite maternal improvement, she was delivered at 31 weeks of gestation for persistent nonreassuring fetal status.

Conclusion: Rifampin may be an effective adjunctive therapy for intrahepatic cholestasis of pregnancy refractory to ursodiol alone. Additional research is needed to assess short-term and long-term maternal and newborn outcomes, because fetal deterioration still occurred in spite of maternal improvement.

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Comment in

  • Adjuvant Use of Rifampin for Refractory Intrahepatic Cholestasis of Pregnancy.
    Rezai S, Gallo D, Payero E, Henderson CE. Rezai S, et al. Obstet Gynecol. 2019 Feb;133(2):384-385. doi: 10.1097/AOG.0000000000003095. Obstet Gynecol. 2019. PMID: 30681532 No abstract available.
  • In Reply.
    Liu J, Murray AM, Mankus EB, Ireland KE, Acosta OM, Ramsey PS. Liu J, et al. Obstet Gynecol. 2019 Feb;133(2):385. doi: 10.1097/AOG.0000000000003096. Obstet Gynecol. 2019. PMID: 30681533 No abstract available.

References

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    1. Wood AM, Livingston EG, Hughes BL, Kuller JA. Intrahepatic cholestasis of pregnancy: a review of diagnosis and management. Obstet Gynecol Surv 2018;73:103–9.
    1. Bacq Y, Sentilhes L, Reyes HB, Glantz A, Kondrackiene J, Binder T, et al. Efficacy of ursodeoxycholic acid in treating intrahepatic cholestasis of pregnancy: a meta-analysis. Gastroenterology 2012;143:1492–501.
    1. Khurana S, Singh P. Rifampin is safe for treatment of pruritus due to chronic cholestasis: a meta-analysis of prospective randomized-controlled trials. Liver Int 2006;26:943–8.
    1. Chappell LC, Chambers J, Thornton JG, Williamson C. Does ursodeoxycholic acid improve perinatal outcomes in women with intrahepatic cholestasis of pregnancy? BMJ 2018;360:k104.

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