2022 43 ICP Flashcards
What are the conditions for diagnosing ICP?
Itching in skin of normal appearance
Peak random total bile acids >19
When are additional lab &/or imaging investigations indicated in ICP?
Atypical clinical symptoms
Relevant comorbidities
Early onset severe ICP
Postnatally if LFTs do no resolve
When should LFTs & TBAs be repeated postnatally for ICP?
> 4 weeks
What are the TBA ranges for diagnosis in ICP?
<19: gestational pruritus
19-39: mild ICP
40-99: moderate ICP
>100: severe ICP
When should birth be planned in ICP?
Mild: 40/40
Moderate: 38-39/40
Severe: 35-36/40
For what TBA level is the rate of stillbirth increased?
Severe: >100
In which women with ICP is the rate of stillbirth further increased?
Gestational diabetes
Pre-eclampsia
Multifetal pregnancy
What is the prevalence of ICP?
0.7% multi-ethnic
1.2-1.5% Indian-Asian & Pakistani-Asian
25% of pregnant women develop itching (gestational pruritus)
When does ICP usually present?
Usually 3rd trimester
Should return to normal after birth
Why can ALT & AST be raised postpartum with no pathology?
Found in smooth muscle, breast & red blood cells
What conditions are mothers with ICP at greater risk of?
Pre-eclampsia
Gestational diabetes
Hepatobiliary disease
Immune-mediated diseases (including diabetes, thyroid disease, psoriasis, inflammatory arthropathies, Crohn’s)
What is the proposed pathophysiology of stillbirth in ICP?
Bile acids
May cause acute fetal anoxic event
Possibly due to fetal arrhythmia
Possibly acute placental vessel spasm
What perinatal morbidities are associated with ICP?
Preterm birth (iatrogenic & spontaneous)
Meconium-stained liquor
Need for neonatal care
What maternal monitoring is advised in ICP?
LFTs & TBAs
All: after 1 week
Mild: weekly as approach 38/40
Moderate: weekly as approach 35/40
Severe: may not need more routinely
What fetal monitoring is advised in ICP?
NOT CTG or USS as do not predict or prevent stillbirth
Fetal movements
