Journal Article

Intrahepatic cholestasis of pregnancy after ovarian hyperstimulation syndrome with wild-type ABCB4 gene: a peculiar case and literature review

Chiantera, Vito, Capobianco, Giampiero, Andrisani, Alessandra, Buzzaccarini, Giovanni, Ambrosini, Guido, Laganà, Antonio Simone, Marin, Loris, Nuzzi, Ludovica, Esposito, Federica

2023

Overview

Background Intrahepatic cholestasis of pregnancy (ICP) in the first trimester occurring after ovarian hyperstimulation syndrome (OHSS) is a rare condition and few cases are reported in the literature. Hyperestrogenism may explain this problem in genetically predisposed women. The objective of this article is to report one of these rare cases and offer an overview of the other published cases. Case presentation We report a case of severe OHSS followed by ICP in the first trimester. The patient was admitted to the intensive care unit and was treated according to the guidelines for the management of OHSS. Moreover, the patient also received ursodeoxycholic acid for ICP, which brought to an improvement of her clinical conditions. The pregnancy continued without other complications until the 36 th week of gestation, when the patient developed ICP in the third trimester and underwent cesarean section for increased bile acid levels and cardiotocographic (CTG) pathologic alterations. The newborn was a healthy baby weighing 2500 gr. We also reviewed other case reports published by other authors about this clinical condition. We present what is, to our knowledge, the first case of ICP developed in the first trimester of pregnancy after OHSS in which genetic polymorphisms of ABCB4 (MDR3) have been investigated. Conclusions ICP in the first trimester might be induced by elevated serum estrogen levels after OHSS in genetically predisposed women. In these women, it might be useful to check for genetic polymorphisms to know if they have a predisposition for ICP recurrence in the third trimester of pregnancy.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Abdomen / Analysis / Ascites / Bile / Blood platelets / Care and treatment / Case Report / Case reports / Cesarean Section - adverse effects / Cholestasis / Cholestasis, Intrahepatic - complications / Cholestasis, Intrahepatic - genetics / Data collection / Diagnosis / Dyspnea / Embryos / Estrogens / Female / Fetuses / First trimester / Gallbladder diseases / Genetic aspects / Genetic polymorphisms / Genetic Predisposition to Disease / Gestational age / gynecological disease / Gynecology / Health aspects / Humans / Hydration / In vitro fertilization / Infant, Newborn / Infertility / Intrahepatic cholestasis of pregnancy / Jaundice, Obstructive / Laboratories / Leukocytes / Literature reviews / Liver / Maternal and Child Health / Medicine / Medicine & Public Health / Ovarian hyperstimulation syndrome / Ovarian Hyperstimulation Syndrome - complications / Ovarian Hyperstimulation Syndrome - genetics / Ovaries / Patients / Permeability / Pregnancy / Pregnancy Complications - drug therapy / Pregnancy, Complications of / Pregnant women / reproductive health / Reproductive Medicine / Reproductive technology / Ultrasonic imaging / Womens health