Intra-hepatic cholestasis of pregnancy GTG

Question 1

How common is ICP?

Answer 1

0.7% pregnancies

Question 1

What % of women developing itching in pregnancy?

Answer 1

25%, majority do not have ICP

Question 2

What level of bile acids are normal in pregnancy

Answer 2

<18
If itching - gestational pruritus

Question 3

Mild ICP

Answer 3

19-39

Question 4

Moderate ICP

Answer 4

40-99

Question 5

Severe ICP

Answer 5

> 100

Question 6

When should liver screen and liver USS be considered?

Answer 6

Atypical clinical symptoms
Early onset severe ICP (1st/2nd trimester)

Other abnormality that does not fit wit ICP - prolonged PT, metabolic dysfunction such as hypoglycaemia
No resolution post-nasally (normally itching improves with 1st few days, and LFT normal by 4 week)

Question 7

What % of ICP develop PET

Answer 7

12% (3.4% BG)

Question 8

What % of ICP develop GDM

Answer 8

13% (5.9% BG)

Question 9

Risk of stillbirth mild ICP

Answer 9

0.13% background

Question 10

Risk of stillbirth moderate ICP

Answer 10

0.28% similar until 38-39weeks

Question 11

Risk of stillbirth severe ICP

Answer 11

3.44% high

Question 12

Risk of preterm birth
Mild
Moderate
Severe

Answer 12

Mild 16.5%
Moderate 19%
Severe 30%

Question 13

After Dx when should repeat LFT and BA be performed

Answer 13

1 week, then determine frequency

Question 14

Can risk of stillbirth be predicted?

Answer 14

No
CTG and USS not helpful

Question 15

What symptomatic treatments can be offered?

Answer 15

Topical emollients - aqueous +/- methanol
Anti-histamines
Consider Vit K treatment if reduced absorption of diety fats/abnormal PT

Question 16

Timing of birth mild ICP

Answer 16

Deliver by 40 weeks

Question 17

Timing of birth moderate ICP (and no other RF)

Answer 17

Delivery by 38-39 weeks

Question 18

Timing of birth severe ICP

Answer 18

Deliver by 35-36 weeks

Question 19

Does ICP impact mode of delivery

Answer 19

No

Question 20

Should ICP be offered monitoring in labour

Answer 20

Yes if >100

Question 21

Can women with ICP take oestrogen containing contraction?

Answer 21

UK MEC 2

Can take if have not developed cholestasis following oestrogen therapy

Question 22

Can women who have had ICP take HRT

Answer 22

Yes

Question 23

Impact on future pregnancies if ICP

Answer 23

Increased risk ICP
Take LFT and BA at booking