Late Pregnancy Complications

Question 1

Intrahepatic cholestasis of pregnancy: epidemiology

Answer 1

0.7% pregnancies
more common in third trimester

Question 2

Intrahepatic cholestasis of pregnancy: risk factors

Answer 2

previous ICP, FHx ICP
previous hepatitis C
cholelithiasis

Question 3

Intrahepatic cholestasis of pregnancy: clinical features

Answer 3

pruritus and liver dysfunction (raised total serum bile acid concentrations)

Question 4

Intrahepatic cholestasis of pregnancy: investigations

Answer 4

serum total bile acids
liver function tests

Question 5

Intrahepatic cholestasis of pregnancy: management

Answer 5

risk of stillbirth only increased if serum BA ≥100

<100 - treat symptomatically
- emollients
- sedative antihistamines (chloramphenamine)

≥100 and 35+/40
- offer delivery (IOL or elective caesarian section)

Question 6

Intrahepatic cholestasis of pregnancy: complications

Answer 6

maternal
- increased risk GDM, pre-eclampsia, dyslipidaemia

fetal
- pre-term labour
- meconium-stained amniotic fluid
- neonatal respiratory distress syndrome
- stillbirth (BA ≥100)

Question 7

Intrahepatic cholestasis of pregnancy: monitoring

Answer 7

weekly blood tests (serum bile acids + LFT) from 32/40