Intrahepatic Cholestasis Of Pregnancy+ Other Liver Pathology Flashcards
What is Gestational pruritis
Itching with peak bile acid <19umol/l
Mild ICP bile acid level
19-39umol/l
Moderated ICP- bile acid level
40-99umol/l
Severe- bile acid level
> /= 100umol/l
Incidence of ICP
0.7%
Clinical issues (6) ICP
- symptom control
- fetal monitoring
- preterm birth
- stillbirth risk
- difficulty sleeping
- timing of delivery
How is intrahepatic cholestasis of pregnancy diagnosed
Resolution of
- symptoms,
- Lft and bile salts
4 weeks postpartum
Who to request viral screen and liver ultrasound for (5)
- unsure diagnosis
- early onset severe disease
- markedly elevated transaminases
- liver failure
- no resolution postpartum
ICP increases the risk of ……… in pregnancy(2)
Pre eclampsia
Gestational diabetes
Frequent symptoms of ICP (3)
- generalized itching
- itching to palms and soles
- itching worse at Night
Infrequent symptoms of ICP (4)
- dark urine
- pale stools
- steatorrhoea
- jaundice
Risk of developing hepatobiliary disease
15%
Prevalence of stillbirth with severe ICP
3.44%
Fetal complications moderate to severe ICP (4)
- stillbirth
- meconium stained liquor
- neonatal care
- preterm birth
Frequency of biochemical monitoring for cholestasis if pregnancy
1 week post diagnosis then based on clinical picture
MOA of ursodeoxycholic acid
- 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
Timing of birth : Mild disease
<40 weeks
Timing of birth: moderate disease
38-39weeks
Timing of birth: severe disease
35-36 weeks
Mode of delivery in ICP
Induction of labour
Estrogen containing contraception
UKMEC
Class 2
(If no history if ocp induced cholestasis)
Non estrogen contraception
UKMEC
CLASS 1
Treatment options of ICP
Antihistamines for itching
- loratidine
- chlorphenamine
Recurrence rate of ICP
45-90%
What benign liver pathology is associated with combined hormonal contraception
HEPATIC ADENOMA
What is the lifetime risk.of haemorrhage within a hepatic adenoma
27%
Lifetime risk of rupture and intraperitoneal bleed in hepatic adenoma
17%
