Intrahepatic Cholestasis of Pregnancy (ICP)

Flashcards covering key vocabulary and concepts related to Intrahepatic Cholestasis of Pregnancy (ICP).

Intrahepatic Cholestasis of Pregnancy (ICP)

A disorder of the liver where the normal flow of bile out of the liver is reduced; affects 1:140 pregnancies in the UK.

Bile

Yellow-green fluid produced by the liver containing chemicals to aid digestion (including bile acids) and waste products for excretion (including bilirubin).

Common Hepatic Duct

Formed by small hepatic ducts joining together, carrying bile from the liver cells.

Gallbladder

Stores bile and is attached to the common bile duct via the cystic duct.

Duodenum

Part of the small intestine where the common bile duct carries bile.

Function of Bile in Intestines

Acts as a detergent, breaking down fats into small droplets for absorption and enabling uptake of fat-soluble vitamins (A, D, E, K).

Symptoms of ICP

Pruritus (itching) without rash, particularly on palms and soles (often worse at night), loss of appetite, malaise, jaundice, pale stools.

Risk Factors for ICP

History of ICP (recurrent rate of 40-70%), family history (1st degree relative), ethnicity (Indian, Pakistani, or South American), Hep C or liver conditions, winter season, assisted reproduction, progesterone supplements, multiple pregnancies.

Maternal Implications of ICP

Coping with itching, difficulty sleeping, anxiety, risk of GDM and PET, increased risk of hepatobiliary disease in later life, Vitamin K deficiency.

Fetal Implications of ICP

Risk of premature birth, meconium liquor, need for neonatal care, and stillbirth (linked to bile acids).

Assessment and Diagnosis of ICP

Same-day referral, careful history taking, exclusion of other causes, urine dipstick for proteinuria, blood pressure check, CTG (?), and blood tests (LFTs, bile acids, viral screening, liver autoimmune screening).

Other Causes to Exclude in ICP Diagnosis

Stretch marks, drug/allergic reactions, PUP, chilblains, dry skin, eczema, diabetes, athlete's foot.

Antenatal Management of ICP

Topical emollients and antihistamines for pruritus, frequent blood tests for LFTs and bile acids, Ursodeoxycholic acid (for pruritus and liver function), Vit K (if needed), monitoring fetal movements.

Intrapartum Management of ICP

Advised to give birth in an obstetric unit; timing depends on severity of cholestasis and presence of other risk factors (35-36 weeks for severe, 38-39 weeks for moderate, 40 weeks for mild).

Postpartum Management of ICP

Liver function and bile acid blood tests at least 4 weeks after birth, advice on increased risk in future pregnancies, baseline LFTs and bile acid blood tests in future pregnancies.