Highlighter is on. Drag to highlight text. Click a highlight to remove it.
ALL / Gastroenterology

Pregnancy: jaundice

Pregnancy: jaundice

Intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis of pregnancy (also known as obstetric cholestasis) occurs in around 1% of pregnancies and is generally seen in the third trimester. It is the most common liver disease of pregnancy.

Features
  • Pruritus, often in the palms and soles
  • No rash (although skin changes may be seen due to scratching)
  • Raised bilirubin

Management
  • Stillbirth risk only rises significantly when bile acids ≥100 µmol/L
    • Mild ICP (19–39 µmol/L): risk similar to background; consider planned birth by 40 weeks or routine antenatal care.
    • Moderate ICP (40–99 µmol/L): risk remains low until 38–39 weeks; consider delivery at 38–39 weeks.
    • Severe ICP (≥100 µmol/L): increased stillbirth risk; consider delivery at 35–36 weeks.
  • Symptomatic relief of itch with emollients
  • No treatments improve fetal outcomes
    • Do not routinely use ursodeoxycholic acid to reduce perinatal risk.
Complications include an increased rate of stillbirth. It is not generally associated with increased maternal morbidity


Acute fatty liver of pregnancy

Acute fatty liver of pregnancy is rare complication which may occur in the third trimester or the period immediately following delivery.

Features
  • abdominal pain
  • nausea & vomiting
  • headache
  • jaundice
  • hypoglycaemia
  • severe disease may result in pre-eclampsia

Investigations
  • ALT is typically elevated e.g. 500 u/l

Management
  • support care
  • once stabilised delivery is the definitive management


Gilbert's, Dubin-Johnson syndrome, may be exacerbated during pregnancy

HELLP
  • Haemolysis, Elevated Liver enzymes, Low Platelets
+PassMedicine Notes

Intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis of pregnancy (also known as obstetric cholestasis) occurs in around 1% of pregnancies and is generally seen in the third trimester. It is the most common liver disease of pregnancy.

Features
  • Pruritus, often in the palms and soles
  • No rash (although skin changes may be seen due to scratching)
  • Raised bilirubin
Management
  • Stillbirth risk only rises significantly when bile acids ≥100 µmol/L
    • Mild ICP (19–39 µmol/L): risk similar to background; consider planned birth by 40 weeks or routine antenatal care.
    • Moderate ICP (40–99 µmol/L): risk remains low until 38–39 weeks; consider delivery at 38–39 weeks.
    • Severe ICP (≥100 µmol/L): increased stillbirth risk; consider delivery at 35–36 weeks.
  • Symptomatic relief of itch with emollients
  • No treatments improve fetal outcomes
    • Do not routinely use ursodeoxycholic acid to reduce perinatal risk.
Complications include an increased rate of stillbirth. It is not generally associated with increased maternal morbidity

Acute fatty liver of pregnancy

Acute fatty liver of pregnancy is rare complication which may occur in the third trimester or the period immediately following delivery.

Features
  • abdominal pain
  • nausea & vomiting
  • headache
  • jaundice
  • hypoglycaemia
  • severe disease may result in pre-eclampsia
Investigations
  • ALT is typically elevated e.g. 500 u/l
Management
  • support care
  • once stabilised delivery is the definitive management

Gilbert's, Dubin-Johnson syndrome, may be exacerbated during pregnancy

HELLP
  • Haemolysis, Elevated Liver enzymes, Low Platelets


Links
Canadian Journal of Gastroenterology
👍 9👎 5
Acute Fatty Liver of Pregnancy
Saved ✓

MEDIA