Intrahepatic Cholestasis of Pregnancy..Part 1.. A common Liver disorder in Pregnancy during the last part of Pregnancy...Part 2 will be added soon.

1. Intrahepatic Cholestasis of Pregnancy Dr. Tkiak 2011.06.11 Part I

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

7. 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

8. Still Birth (IUFD) Premature Delivery Meconium Staining

10. 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

13. 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