Intrahepatic Cholestasis Of Pregnancy+ Other Liver Pathology

Question 1

What is Gestational pruritis

Answer 1

Itching with peak bile acid <19umol/l

Question 2

Mild ICP bile acid level

Answer 2

19-39umol/l

Question 3

Moderated ICP- bile acid level

Answer 3

40-99umol/l

Question 4

Severe- bile acid level

Answer 4

> /= 100umol/l

Question 5

Incidence of ICP

Answer 5

0.7%

Question 6

Clinical issues (6) ICP

Answer 6

• symptom control
• fetal monitoring
• preterm birth
• stillbirth risk
• difficulty sleeping
• timing of delivery

Question 7

How is intrahepatic cholestasis of pregnancy diagnosed

Answer 7

Resolution of
- symptoms,
- Lft and bile salts

4 weeks postpartum

Question 8

Who to request viral screen and liver ultrasound for (5)

Answer 8

• unsure diagnosis
• early onset severe disease
• markedly elevated transaminases
• liver failure
• no resolution postpartum

Question 9

ICP increases the risk of ……… in pregnancy(2)

Answer 9

Pre eclampsia
Gestational diabetes

Question 10

Frequent symptoms of ICP (3)

Answer 10

• generalized itching
• itching to palms and soles
• itching worse at Night

Question 11

Infrequent symptoms of ICP (4)

Answer 11

• dark urine
• pale stools
• steatorrhoea
• jaundice

Question 12

Risk of developing hepatobiliary disease

Answer 12

15%

Question 13

Prevalence of stillbirth with severe ICP

Answer 13

3.44%

Question 14

Fetal complications moderate to severe ICP (4)

Answer 14

• stillbirth
• meconium stained liquor
• neonatal care
• preterm birth

Question 15

Frequency of biochemical monitoring for cholestasis if pregnancy

Answer 15

1 week post diagnosis then based on clinical picture

Question 16

MOA of ursodeoxycholic acid

Answer 16

• decreases pruritus (not statistically significant
• increases hepatobilliary transport
• decreases hepatotoxic effects of bile salts in mother and fetus

NB: does not improve overall outcome so do not offer routinely

Question 17

Timing of birth : Mild disease

Answer 17

<40 weeks

Question 18

Timing of birth: moderate disease

Answer 18

38-39weeks

Question 19

Timing of birth: severe disease

Answer 19

35-36 weeks

Question 20

Mode of delivery in ICP

Answer 20

Induction of labour

Question 21

Estrogen containing contraception
UKMEC

Answer 21

Class 2
(If no history if ocp induced cholestasis)

Question 22

Non estrogen contraception
UKMEC

Answer 22

CLASS 1

Question 23

Treatment options of ICP

Answer 23

Antihistamines for itching
- loratidine
- chlorphenamine

Question 24

Recurrence rate of ICP

Answer 24

45-90%

Question 25

What benign liver pathology is associated with combined hormonal contraception

Answer 25

HEPATIC ADENOMA

Question 26

What is the lifetime risk.of haemorrhage within a hepatic adenoma

Answer 26

27%

Question 27

Lifetime risk of rupture and intraperitoneal bleed in hepatic adenoma

Answer 27

17%