Pruritis in pregnancy - go over notes

Question 1

Pregnancy with pruritis can be split into w/ rash [3] or non-rash [1]

What are they?

Answer 1

Pruritis without rash:
- Intrahepatic cholestasis of pregnancy (ICP)

Pruritis with rash:
* Polymorphic eruption of pregnancy (PEP)
* Atopic eruption of pregnancy (AEP)
* Pemphigoid gestationis

Question 2

What is the cause of intrahepatic cholestasis of pregnancy? [1]

Answer 2

impaired bile flow with combination of hormonal, genetic and environmental factors -> deposition of bile salts in the skin, elevated levels of lysophosphatidic acid (LPA) and a sulfated metabolite of progesterone called PM3S (pruritogens)

Question 3

What are the complications of ICP? [5]

Answer 3

• stillbirth (if BAs >100)
• premature delivery — mainly iatrogenic
• fetal distress
• meconium aspiration
• vitamin K deficiency

Question 4

Investigations for ICP? [2]

Answer 4

• Elevated serum bile acids (itch may precede) > 19
• Abnormal liver function tests (LFTs)

Alongside symptoms

Question 5

How do you manage ICP (depending on the severity - e.g. mild, moderate and severe) [3]

Answer 5

• Weekly monitoring
• Refer to specialist services if severe and early
• Mild 19-39: deliver 40/40
• Mod 40-99: deliver 38-39/40
• Severe >100: deliver 35-36/40

Question 6

Describe the presentation of POLYMORPHIC ERUPTION OF PREGNANCY (PEP) [3]

Answer 6

Rash has pruritic urticarial papules that coalesce into plaques

Abdomen striae with UMBILICUS sparing

May spread to buttocks / proximal thigh

Question 7

How do you manage PEP? [2]

Answer 7

Topical corticosteroids
Oral corticosteroids

Question 8

Which form of pruritis in pregnancy is most likely in first trimester? [1]

Answer 8

ATOPIC ERUPTION OF PREGNANCY (AEP)

Question 9

How do you manage pemphigoid gestationis? [3]

Answer 9

Refer dermatology
Oral corticosteroids
Increased antenatal surveillance + inform neonatal team