Intrahepatic Cholestasis of pregnancy

1. Intrahepatic
Cholestasis
of pregnancy

2. Introduction
 It’s a disorder of poorly understood cause, but may occur due to the
cholestatic effect of estrogen during pregnancy (can occur while using OCP )
 Characterized by generalized pruritis (itching ) with no rash especially on
palms and soles and elevated bile salts and liver function test
 It develops late in pregnancy

3. Introduction
 More in multifetal pregnancy
 Occur in 0.7 % of pregnancies
 1/3 of the cases has a positive family history (genetic disposition + )
 A diagnosis of exclusion
 50-90 % recurrence

4. Investigations
 Liver function test : elevated alkaline phosphatase and AST , ALT
(the most usual)
 Serum bile acids : elevated
 Ultrasound to exclude biliary obstruction and other hepatic-biliary
disorders as gall stones
 Exclude other causes of itching
 Exclude other causes of abnormal liver function test as hepatitis,
HELLP syndrome and acute fatty liver of pregnancy

5. Management
 Ursodeoxycholic acid : first line treatment , it improves maternal symptoms but doesn’t
improve fetal outcome
 Antihistamines and topical emollients
 It may increase the risk of late fetal death (very slight increase if any )
 Early induction of labor is not justified

6. Management
 No approved method for antenatal fetal monitoring
 Maternal serum liver function test is needed
 Liver function test should be repeated at least 10 days postpartum
 Avoid COC as a contraception method

7. Risks
 Postpartum hemorrhage (vitamin k deficiency due to fat malabsorption )
 Preterm labor
 Meconium stained amniotic fluid
 Fetal distress
 Intrauterine death (rare )

8. Introduction
 Incidence 5 :100.000 pregnancy
 Recurrence is uncommon
 Can has genetic background
 More in multiple pregnancy ,third trimester and nulliparas
 Maternal mortality and morbidity is 1.8 %
 Perinatal mortality and morbidity is 10 %

9. Acute fatty liver of
pregnancy

10. Introduction
 Present in the third trimester with abdominal pain , vomiting ,
anorexia and sometimes jaundice
 It can be accompanied with high blood pressure
 Can be presented with diabetes insipidus (polyurea, polydipsia )
 Can present by hypoglycemia , renal impairment or DIC

11. Lab findings
*Shares the findings of HELLP syndrome and DIC
Abnormal liver function test
Elevated serum uric acid
Hypoglycemia
Leukocytosis
Abnormal coagulation profile

12. Management
Correction of hypoglycemia and coagulopathy
Then ….
DELIVERY

13. ICP (intahepatic cholestasis of pregnancy) AFLP (acute fatty liver of pregnancy)