Elevated international normalized ratio (INR) and new diagnosis of hepatitis C associated with severe intrahepatic cholestasis of pregnancy (ICP): A case report

Courtney Birchall; Danielle Prentice; Jaimey Pauli

doi:10.1016/j.crwh.2020.e00178

Elevated international normalized ratio (INR) and new diagnosis of hepatitis C associated with severe intrahepatic cholestasis of pregnancy (ICP): A case report

Case Rep Womens Health. 2020 Jan 30:26:e00178. doi: 10.1016/j.crwh.2020.e00178. eCollection 2020 Apr.

Authors

Courtney Birchall¹, Danielle Prentice², Jaimey Pauli²

Affiliations

¹ Obstetrics and Gynecology Penn State Health Milton S. Hershey Medical Center, USA.
² Maternal Fetal Medicine Penn State Health Milton S. Hershey Medical Center, USA.

Abstract

Background: Severe intrahepatic cholestasis of pregnancy (ICP), defined as a serum bile acid (SBA) level > 100 μmol/l, remains poorly understood in its mechanism and implications.

Case: A patient with a missed diagnosis of mild ICP went on to develop clinical jaundice and liver function abnormalities in the setting of newly diagnosed hepatitis C and severe ICP on repeat SBA testing.

Conclusion: This case highlights and adds to the growing body of evidence supporting the need for universal screening for hepatitis C in ICP patients and the potential role for repeat SBA testing, which would be a notable change from the traditional care of these individuals.

Keywords: ALT, Alanine aminotransferase; AST, Aspartate aminotransferase; Bile acids; Cholestasis; Hepatitis C; ICP, Intrahepatic cholestasis of pregnancy; INR, International normalized ratio; Pregnancy; SBA, Serum bile acid.

Publication types

Case Reports