Intrahepatic Cholestasis of Pregnancy

Intrahepatic Cholestasis of Pregnancy Dr. Tkiak 2011.06.11 Part I

Intrahepatic Cholestasis of Pregnancy “ Delivery is the only solution to reduce Clinical symptoms and reduce abnormal Biochemical Results to normal to a nullipara”

What is ICP? ,[object Object],[object Object]

Pathogenesis: “UNKNOWN”?? ,[object Object],[object Object],[object Object],[object Object],[object Object]

Epidemiology ,[object Object],[object Object],[object Object],[object Object],[object Object]

Signs and Symptoms ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Fetal Complications Note: Maternal consequences include severe puritus with increasing gestational weeks and rarely Post-Partum Hemorrhage (PPH). <0.1 Intra-crainal Hemorrhage (rare) Meconium Staining 1-2 Still Birth (IUFD) 22-33 Fetal Distress 19 -60 Premature Delivery Risks (%) Fetal complications

Still Birth (IUFD) Premature Delivery Meconium Staining

How is Cholestasis of pregnancy diagnosed? ,[object Object],[object Object],[object Object],[object Object],[object Object]

Less Useful Mild-mod increase >10 fold in Ser.ICP Most sensitive Indicator 2-10xNR 2-10xNR comments 30-117u/L ALP 0.2-5.2mg/dL 0-1mg/dL Bilirubin 17mmol/L <3.1mmol/L Cholic Acids > 40mmo/L 6.6-11.00mmo/L Total Bile Acids 119+/-51u/L 0-40u/L AST 131+/-96u/L 0-37u/L ALT Ave Values in ICP Normal Range (NR) Tests Lab Diagnosis: Biochemical Tests for ICP

The treatment goals for cholestasis of pregnancy are to relieve itching. Some treatment options include ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Puritus after 20 wks gestation of pregnancy in absence of othe medical or dermatological condition SBA level <10mmol/L SBA level >11mmol/L ,[object Object],[object Object],[object Object],[object Object],Mild ICP-SBA level 11-39 Expectant Management Severe ICP->40mmol/L Active management ,[object Object],[object Object],[object Object],[object Object],37 <weeks Gestation 37 >weeks Gestation Rising SBA >40mmol/l Increase in Symptoms 40 weeks gestation <34 weeks gestation Administer Beta or Dexamethasone per protocol Admission to hospital Cont . Monitoring Cont.UCDA Additional Comfort measures Non -Reasuring fetal status Considered Induction of Labor Draw SBA levels LFTs Baseline Fetal Monitoring (NST/BPP ) ICP management Protocol : BPP-Biophysical Profile;LFTs= Liver Function Test;NST=Non-Stress Test;SBA=Serum Bile Acids;UCDA=Ursodeoxycholic Acid

Women treated with chlestyramine should be given supplemental fat soluble vitamines & Vit K (10mg/day) Glucocorticord anti-inflammatory effect 12 mg/day comes in 2,4,6 mg tabs Dexamthasone (Decadrone) Natural water soluble Bas that injure cell membranes ; reduce relase of puritic agents 900 mg-2mg/day Comes in 300mg tabs Ursodeoxyxholic Acid (Actigall) Bile acid sequestran that binds Bile Acids in the gut to facililiate excretion 4mg BID Cholestyramine (Questran) Antihistamine 25-50mg/day comes in 25mg 0r 50 mg Hydroxyzine (Vistaril) Antihistamine 4mg tid;comes in 4mg or 8mg tabletes Chlorpheniramine (Chlor-Trimeton) Mechanism of Action Dose Medication Pharmacologic Treatment of ICP

NOTE ,[object Object],[object Object]

[object Object],What are the chances of the mother getting Cholestasis in another pregnancy?

Intrahepatic Cholestasis of Pregnancy

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