Intrahepatic cholestasis of pregnancy
You don't need to be Editor-In-Chief to add or edit content to WikiDoc. You can begin to add to or edit text on this WikiDoc page by clicking on the edit button at the top of this page. Next enter or edit the information that you would like to appear here. Once you are done editing, scroll down and click the Save page button at the bottom of the page.
| Intrahepatic Cholestasis of Pregnancy Classification and external resources | |
| ICD-10 | O26.6 |
|---|---|
| ICD-9 | 646.73 |
| DiseasesDB | 6884 |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-525-6884
Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [2] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.
Intrahepatic Cholestasis of Pregnancy (ICP), also termed Obstetric Cholestasis in the United Kingdom, gives rise to troublesome itching during pregnancy but may lead to possibly serious complications for the mother and very serious outcomes for the fetus.
Itching has long been considered to be a common symptom of pregnancy. The vast majority of times, itching, or pruritus is a minor annoyance caused by changes to the skin, especially that of the abdomen. However, there are instances when itching is a symptom of ICP.
ICP occurs most commonly in the third trimester, but can begin at any time during the pregnancy.
Risks if untreated
Maternal consequences include the following:
- Itching, which can become intense and debilitating
- Premature labor
- Deranged clotting, which requires Vitamin K
Fetal consequences include:
- Stillbirth
- Meconium ingestion
- Meconium aspiration syndrome
Delivery before the beginning of the 38th week is considered to be crucial for the best fetal outcome.[citation needed]
Signs and symptoms
Hallmarks of ICP include the following symptoms:
- Itching of the palms of the hands and soles of the feet without presence of a rash
- Itching that increases in the evening
- Darker urine
- Lighter stools
- Increased clotting time
- Fatigue
- Increased nausea
- Decrease in appetite
- Jaundice
- Premature labor
It is important to note that not all ICP sufferers have all of the above symptoms. For example, Jaundice only occurs in relatively small subset of cases.
Diagnosis
Whilst most pregnant women experience some itch from time to time, itching on the palms and soles without a visible rash, or persisting severe or extenive itch symptoms should be reported to the midwife or obstetrican.
To obtain a diagnosis of ICP, a blood test is arranged to check the liver function tests (LFTs). This is a simple blood test, the results of which should be available by the next day. If the ALT level is elevated, this, plus pruritus of palms and soles, should be treated as diagnostic of ICP. Another blood test for ICP is a quantitative measurement of bile salts. The results of this test often take longer to return, but the test is more specific for ICP.
Other problems with the liver that occur in pregnancy should be considered by the treating clinician. These include preeclampsia, the HELLP syndrome, and acute fatty liver of pregnancy. Furthermore, other causes of hepatitis, like hepatitis viruses and certain medications, should also be considered.
Treatment
Upon diagnosis, most providers will prescribe Ursodeoxycholic Acid. However, some will prescribe Cholestyramine. While there is no cure for ICP, and no way to guarantee a successful outcome, studies have shown a slightly better fetal and maternal outcome from administration of Ursodeoxycholic Acid, whereas Cholestyramine appears to only relieve itching.[citation needed]
If additional blood tests to check clotting function identify a problem, giving Vitamin K may help avoid the risk of hemorrhage at delivery, and the necessity of early delivery.
Delivery before the beginning of the 38th week is considered crucial to fetal outcome. [1]
References
See also
- Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP) an itchy condition of pregnancy that is associated with a rash.
External links
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
