Intrahepatic Cholestasis Of Pregnancy

Question 1

Definition of ICP

Answer 1

Itching; Bile Acids >19

Question 2

When to investigate cause if raised bile acids

Answer 2

-Atypical presentation
- very high ALT/AST
- early onset 1st/2nd tri *
- rapid progression of bloods
- liver failure
- acute infection
- no resolution 4wks postpartum *
* referral to hep

Question 3

Severity classification

Answer 3

Mild - 19-39
Moderate - 40-99
Severe >100

Question 4

ICP Prevalence

Answer 4

0.7% all ethnicities
1.2-1.5% Indian Asian / Pakistani Asian

Question 5

Monitoring

Answer 5

First raised BA- repeat 7/7
Then
Mild - 1-2wkly, wkly around 39/40
Mod - weekly
Severe- no indicated as no mx change

No influence on USS

Question 6

Possible pathophysiology of stillbirth in ICL

Answer 6

Raised BA -> arrthymia or placental vessel spasm -> anoxic event

Question 7

Stillbirth rates- singleton (ICP)

Answer 7

National SB Rate - 0.29%
Mild- 0.13%
Moderate 0.20%
Severe 3.44%

Question 8

Stillbirth rates twins (ICP)

Answer 8

National 0.8%
BA 10-39 3.3%
>40 5.1%

Question 9

Management of ICP

Answer 9

Symptoms- emollient and antihistamines
If steatorrheoa- coag test +- vit K

Question 10

Risks

Answer 10

-Still birth
-Preterm birth iatrogenic/spontaneous
- meconium
- NICU

Question 11

Birth plans

Answer 11

Mild <_ 40wks (no change to monitoring)

Mod 38-39 (consider continuous)

Severe 35-36 (continuous CTG)

Question 12

Preterm birth rates for ICP severities

Answer 12

Mild 16%
Mod 19%
Severe 30%