Recurrent cholestatic jaundice of pregnancy. Report of five cases and electron microscopic observations

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Abstract
Thirteen episodes of recurrent cholestatic jaundice of pregnancy occurring in 5 women are reported. The disease appeared during the last trimester of the 1st or any subsequent pregnancies. Once present, it recurred in all following full-term pregnancies. The only clinical symptom was itching; on 2 occasions pruritus was unaccompanied by jaundice. Fever and hepatosplenomegaly were absent. Increased urobilinogen excretion was a rule. Both the direct and indirect bllirubin fractions were elevated, but the total bilirubin never exceeded 5 rag/100 cc. As a rule the serum alkaline phosphatase and the total cholesterol were elevated while serum albumin was decreased. The flocculation tests were always normal. In one case the disease persisted 42 days after intrauterine fetal death. All symptoms and laboratory abnormalities disappeared shortly after delivery, leaving no detectable liver damage. Electron microscopy of the liver in one patient revealed dilatation of the bile capillaries as well as flattening and distortion of the microvilli. Premature labor was a rule, and the fetal mortality was higher than expected. The pathogenesls of the disease is discussed and its similarity to 17-alkyl steroid jaundice is stressed.

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