ICP

Question 1

percentage of pregnant women devlop itching

Answer 1

25%

Question 2

ICP affect what percent of pregnancies

Answer 2

0.7%

Question 3

Do we use isolated raised transaminases alone to diagnose ICP

Answer 3

NO

Question 4

onset of symptoms of icp is most common in which trimester

Answer 4

3rd trimester

Question 5

Bile acid <19 umol/l indicates

Answer 5

gestational pruritis

Question 6

Mild, moderate and severe ICP bile acidd ranges

Answer 6

mild: 19-39
moderate: 40-99
severe: >100

Question 7

Still birth rate with severe ICP

Answer 7

3.4%

compared to 0.3% background

Question 8

follow up in mild, moderate and severe ICP

Answer 8

mild: weekly testing as the approach 38w
moderate: weekly testing as the approach 35w
severe: testing not routinely needed

Question 9

When to deliver mild,moderate severe ICP

Answer 9

mild: by 40w
moderate: 38-39w
severe: 35-36w

Question 10

when to do coagulation testing in icp

Answer 10

failure of liver synthetic function
or
failure of fat absorption (steatorrhea)

Question 11

when to seek specialist hepatology advice in icp

Answer 11

• severe ICP
• very early
• atypical
• who don’t have resolution of itch and bichemical abnormalities after birth

Question 12

ICP symptoms

Answer 12

itching without rash
inc. serum bile acid

Question 13

when to test LFT and bile acids after birth

Answer 13

at least 4 w after birth

Question 14

character of itching in ICP

Answer 14

affect palm and soles
pronounced at night (interfere w/ sleep)
+ dark urine and pale stool
+- steatorrhea and malabsorption of vit K

Question 15

how should women w/ icp be monitored

Answer 15

consultant led maternity unit

Question 16

when to measure LFTS and bile acid after the diagnosis measurement

Answer 16

after 1 week and assess

Question 17

fetal monitoring in icp

Answer 17

u/s and/or ctg isn’t routine
- mother to monitor fetal movements

icp not associated w/ FGR or placental insufficincy,so no need of us/ctg

Question 18

what drugs used in ttt of ICP

Answer 18

only symptomatic ttt: antihistamines
(topical emollient: aqueous cream)

no role for any ttt in improving preg. outcome (rifampicin)

Question 19

do we give ursodeoxycholic acid in icp

Answer 19

no
(may be benefitial in women w/ bile acid >40 at 34-36w in reducing PTL

Question 20

main side effect of UDCA

Answer 20

GIT upset

Question 21

when to give vit k in icp

Answer 21

in case of fat malabsorption (steatorrhea) -> coag. profile (abnormal Prothrombin time)

consider water soluble vit k: menadiol sodium phosphate 10 mg daily)

Question 21

if UDCA is given in ICP what is the dose

Answer 21

15 mg/kg daily
as a single dose or in two divided doses

Question 22

mode of bith in ICP

Answer 22

vaginal, IOL or CS

Question 23

indications of CEFM

Answer 23

1. severe ICP 2. GDM, PET, multiple preg. 3. meconium stained liquor( common in moderate & severe ICP)

Question 24

if itching or biochemical abnormalities presist beyond 6 w postpartum

Answer 24

consider other diagnoses refer to hepatologist

Question 25

what contraception should be used ith caution in ICP

Answer 25

* CHC UKMEC 2: unless itching and lfts resolve before starting * if recurrence of sym after using CHC: UKMEC 3 * HRT safe

Question 26

recurrence rate of ICP in future preg.

Answer 26

45-90% | baseline LFT and bile acid to be performed at booking & repeat if needed

Question 27

Acute fatty liver of pregnancy typically occurs in what trimester | life threatening complication of preg

Answer 27

third up to 20% present postnatally

Question 28

the most important serum marker for AFLP

Answer 28

hypoglycemia glucose <4mmol/l

Question 29

management of AFLP

Answer 29

- MD: HDU - aggresively treat coagulopathy and hypoglycemia (FFP & vit K, 50% dextrose respectively) - screen baby for LCHAD def. - laaison with hepatology: plasma exchange or liver transplant ( no improvement in LFT or encephalopathy)

Question 30

recurrence risk of AFLP in. future preg.

Answer 30

25% | more likely if heterozygous for LCHAD def.

Question 31

VIT K is responsible for manufacturing which caog. factor?

Answer 31

10 9 7 2

Question 32

which is the main enzyme raised in ICP

Answer 32

ALT serum bile acid is the most imp. marker for diagnosis & monitoring