Intra-hepatic cholestasis of pregnancy GTG Flashcards
How common is ICP?
0.7% pregnancies
What % of women developing itching in pregnancy?
25%, majority do not have ICP
What level of bile acids are normal in pregnancy
<18
If itching - gestational pruritus
Mild ICP
19-39
Moderate ICP
40-99
Severe ICP
> 100
When should liver screen and liver USS be considered?
Atypical clinical symptoms
Early onset severe ICP (1st/2nd trimester)
Other abnormality that does not fit wit ICP - prolonged PT, metabolic dysfunction such as hypoglycaemia
No resolution post-nasally (normally itching improves with 1st few days, and LFT normal by 4 week)
What % of ICP develop PET
12% (3.4% BG)
What % of ICP develop GDM
13% (5.9% BG)
Risk of stillbirth mild ICP
0.13% background
Risk of stillbirth moderate ICP
0.28% similar until 38-39weeks
Risk of stillbirth severe ICP
3.44% high
Risk of preterm birth
Mild
Moderate
Severe
Mild 16.5%
Moderate 19%
Severe 30%
After Dx when should repeat LFT and BA be performed
1 week, then determine frequency
Can risk of stillbirth be predicted?
No
CTG and USS not helpful
What symptomatic treatments can be offered?
Topical emollients - aqueous +/- methanol
Anti-histamines
Consider Vit K treatment if reduced absorption of diety fats/abnormal PT
Timing of birth mild ICP
Deliver by 40 weeks
Timing of birth moderate ICP (and no other RF)
Delivery by 38-39 weeks
Timing of birth severe ICP
Deliver by 35-36 weeks
Does ICP impact mode of delivery
No
Should ICP be offered monitoring in labour
Yes if >100
Can women with ICP take oestrogen containing contraction?
UK MEC 2
Can take if have not developed cholestasis following oestrogen therapy
Can women who have had ICP take HRT
Yes
Impact on future pregnancies if ICP
Increased risk ICP
Take LFT and BA at booking
