Although there is no specific rash associated with ICP (and presence of a rash at first presentation should prompt consideration of dermatological conditions), excoriation marks, pigmented lesions that resemble prurigo, friction blisters and abrasions secondary to the woman's response to pruritus may be observed. It is characterised by abnormal LFTs (particularly aspartate transaminase (AST) and alanine aminotransferase (ALT) elevation) and an intense pruritus in the absence of skin rash and any other cause for the abnormal LFTs. These findings suggest that the presence of additional complications may worsen the fetal prognosis in ICP. Re: Intrahepatic cholestasis of pregnancy, https://stratog.rcog.org.uk/tutorial/tog-online-sba-resource, Pruritus, jaundice, pale stools, dark urine. A 2015 study has reported UDCA and rifampicin dual therapy in women with ICP, and demonstrated a reduction of serum bile acids in 50% of the women treated.33 Further studies are warranted to establish the extent to which rifampicin may be useful in ICP, and also to investigate any potential benefit to the fetus. Ursodeoxycholic acid (UDCA) is the mainstay of pharmacological treatment, and current evidence suggests that it is safe for both the mother and the fetus. Obstetric Cholestasis (OC) affects 0.7% of pregnancies in the United Kingdom1. Cholestasis occurs in just 1 to 2 pregnancies in 1,000. To understand the presentation, investigation and management options for women with ICP. Owing to concerns regarding the prolonged in utero exposure of fetuses to exogenous steroids, dexamethasone is no longer used in the treatment of ICP. ICP affects approximately 0.7% of pregnant women in the UK, equating to approximately 6000 women per year. The preparation should be water soluble, as ICP is associated with a risk of fat malabsorption as a consequence of reduced enterohepatic bile acid circulation. postnatal abnormal liver function tests. 7. Gallstones, either symptomatic or asymptomatic, are reported in up to 13% of women with ICP.4, 13 The ultrasound appearance of the bile ducts is typically normal in ICP; however, the fasting and ejection volumes of the gallbladder are increased. Although it is not licensed for use in pregnancy, it has been widely used and no teratogenicity or congenital abnormalities have been reported. September 01, 2017 | by AJGraham. This causes itching and yellowing of your skin, eyes, and mucous membranes (jaundice). Brainscape is a web and mobile study platform that helps you learn things faster. There's no cure for ICP, but it should go once you've had your baby. 2–2% of pregnancies, 1 causing pruritis and increased serum bile acids, liver transaminases, and, occasionally, bilirubin. Cholestasis of pregnancy is a liver problem. Mothers whose family birth origins are India or Pakistan have a slightly higher risk (1-2%). An individualised decision should be taken when considering the optimal mode of delivery in women with ICP. Antihistamines such as chlorpheniramine and topical agents such as aqueous cream with menthol may be useful adjuncts in the management of pruritus. Several studies12, 13 have reported associations between ICP and gestational diabetes, and ICP and hepatitis C virus infection. In addition to liver function, coagulation profiles should be checked in women with ICP in those with steatorrhoea (fatty stools), because of the risk of malabsorption of fats and fat‐soluble vitamins. The most specific and sensitive marker of ICP is total serum bile acid (BA) levels greater than 10 micromol/L. obstetric cholestasis Vitamin K supplementation Obstetric cholestasis can lead to a reduction of circulating enerohepatic bile acids causing reduced absorption of fat-soluble vitamins. Bile acids have been shown to cause cardiac arrhythmias in an in vitro model of the fetal heart, and this effect is ameliorated by the addition of UDCA to the culture medium.26 Although human data are lacking, there are three case reports of antenatal fetal cardiac arrhythmia in the literature, including drug‐resistant supraventricular tachycardia (SVT), refractory SVT and atrial flutter.27-29 It should be noted that the outcome in all three of these pregnancies was good. In addition, ICP is more common in women with multifetal pregnancy, following in vitro fertilisation treatment, in older women, in those with a history of gallstones or hepatitis C infection and in the sisters of affected women. and you may need to create a new Wiley Online Library account. Bile acids undergo further modification by the action of gut bacteria in the terminal ileum and colon. It is more common in women of South Asian ethnicity. Many women report a diurnal variation in symptoms, with the symptoms worsening at night, leading to disturbed sleep. In response to elevated levels of intrahepatic bile acids, this receptor is responsible for the coordinated downregulation of synthesis and uptake of bile acids, and the upregulation of export. But it is more common in the second and third trimesters. Compared with women with uncomplicated singleton pregnancies, significantly increased risks of both spontaneous and iatrogenic preterm birth (adjusted odds ratio [aOR] 2.25, 95% CI 1.54–3.27 and aOR 8.75, 95% CI 6.19–12.37, respectively), neonatal unit admission (aOR 2.68, 95% CI 1.97–3.65) and stillbirth (aOR 2.58, 95% CI 1.03–6.49) were reported. In animal studies, bile acids have been shown to cause meconium staining of the amniotic fluid as a result of increased gut motility, and preterm labour as a result of increased myometrial contractility and enhanced sensitivity to oxytocin.25. ICP affects approximately 0.7% of pregnant women in the UK, equating to approximately 6000 women per year. The principal hepatic bile acid receptor is farnesoid X receptor (FXR). Williamson C, Hems LM, Goulis DG, Walker I, Chambers J, Donaldson O, Swiet M, Johnston DG. 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