Cholestasis Flashcards
Prevalance of cholestasis
0.7% overall
1.2-1.5% in Indian/Pakistani
Presentation
Itching w raised bile acids- in 3rd T
If 1st/2nd T + raised BA/LFT, speak to hepatologist
Rule out other causes- if skin has rashes- eczama, durg reaction etc
Rise of other LFTs is not significant
Bloods
Initial then 1 week after
F/u based on results
No need for coag unless concerns with clotting
Levels of ICP
BA <19 - Pruritus
BA 19-39 mild ICP
BA 40-99 Mod ICP
BA >100 Severe ICP
F/u for ICP bloods
Mild- weekly esp near 38w to time IOL
Mod- weekly nearing 35w
Severe- Might not need repeating as pt will have IOL early
Other tests (eg USS, viral screen)
Not recommended
Unless concern of other causes- ie. sig raised LFT ?Hep C
AN Complications/risks of ICP
- Higher risk of PET- check BP +urine every visit
- Inc risk of GDM - additional screening not recommended yet
- Inc risk of liver disease PN
No inc risk of FGR
Management
- Emolients to soothe itching
- Antihistamines- piriton
- No medication can help to reduce BA/ improve preg outcome (do not give urso)
- Vit K- if signs of malabsorption and abnormal PTT
Intrapartum complications (mod-severe ICP)
- Inc risk of PTB
- Inc risk of mec
- Inc risk of baby needing NICU care
SB risk (wo other RF)
Not predicted by USS/CTG
BG risk- 0.29%
Mild ICP- same/lower than background risk ( 0.13%)
Mod- Same till 38-39 weeks (0.28% inc at 38 w)
Severe- higher risk (3.44%)
Twins- higher risk of SB
IOL (wo complications)
Mild- term
Mod- 38-39 weeks
Severe- 35-36 weeks
Might be earlier if other complications ie PET
MOD
No inc risk of CS or assisted birth
IOL should be choice of early delivery
Intrapartum mx
- CEFM for severe ICP, discuss for Mod and mild
- Analgesia- all options offered
- No inc risk of PPH
PN f/u
- Repeat BA after 4 weeks- should normalise
- If not, refer for further investigations
Contraception
- can use any form
- Do not give oestrogen if hx of oestrogen asso cholestasis
