ICP

Question 1

What is ICP?

Answer 1

rashless itch and abnormal LFTs

Question 2

When does ICP develop?

Answer 2

Late 2nd or 3rd trimester

Question 3

Factors in which ICP is more common?

Answer 3

-winter
-older maternal age
-history (and family) of ICP

Question 4

Physiology of ICP:

Answer 4

Liver can’t export bile acids into gall bladder so it leaks into bloodstream

Question 5

How to screen for ICP:

Answer 5

-rise in baseline LFT and serum bile acids
- family and personal history
- ask about itching and if rash present

Question 6

Gestational pruritus

Answer 6

Pregnancy itching
Normal bile acids

Question 7

Diagnosis of ICP

Answer 7

Mild ICP: 19-49 bile acids mol/L
Moderate ICP: 50-99 mol/L
Severe ICP: >100 bile acids mol/L

Question 8

Risks with ICP

Answer 8

-preterm birth (1:10 including iatrogenic)
-meconium stained liquor
-NNU admission
-pre eclampsia and GDM

Question 9

Stillbirth and ICP

Answer 9

Risk is only higher than general population when severe ICP

Question 10

Antenatal care for women with ICP

Answer 10

-consultant led
-weekly LFT if necessary
-vigilance in FM

Question 11

ICP treatment

Answer 11

-topical emollients
-antihistamine

Question 12

Time of birth with ICP

Answer 12

mild: await spontaneous labour
Moderate: consider IOL at 39/40
Severe: 36 weeks

Question 13

Postnatal care for women with ICP:

Answer 13

Retake LFTs and bile acids at 4 weeks postpartum and counsel about recurrence (45-90%)