विवरण
Intrahepatic Cholestasis of Pregnancy (ICP) is a liver disorder that specifically occurs during pregnancy, typically in the third trimester. It is characterized by impaired bile flow within the liver, leading to the accumulation of bile acids in the bloodstream. While the exact cause is not fully understood, hormonal changes during pregnancy, genetic factors, and environmental influences may contribute to the development of ICP.
Symptoms of ICP include intense itching, particularly on the hands and feet, which is often more pronounced at night. Other symptoms may include dark urine, pale stools, and jaundice.
ICP poses potential risks to both the mother and the fetus. Increased levels of bile acids in the maternal bloodstream can be associated with adverse pregnancy outcomes, such as preterm birth, fetal distress, and stillbirth. Therefore, early detection and appropriate management are crucial.
सारांश
- Obstetric Cholestasis (OC), also known as Intrahepatic Cholestasis of Pregnancy (ICP), is a liver disorder specific to pregnancy, affecting about 1% of pregnancies. It involves impaired bile flow, leading to elevated bile acids in the bloodstream. Genetics, hormonal influences (estrogen and progesterone), and environmental factors (selenium deficiency) contribute to the condition.
- The primary symptom is pruritus (itching), often generalized but sometimes more pronounced on the palms and soles, typically worsening at night. Patients may also experience right upper quadrant pain, nausea, fatigue, and dark urine, along with associated anxiety and potential mental health issues. Physical examination may reveal scratch marks but often lacks other specific findings.
- Diagnosis involves excluding other causes of pruritus common in pregnancy. Elevated serum bile acid levels (above 10 micromol/L, depending on the lab) and, to a lesser extent, elevated liver enzymes (SGOT/SGPT) support the diagnosis. Routine testing to rule out viral or autoimmune etiologies is no longer considered necessary by updated guidelines unless atypical symptoms are present.
- Untreated OC poses fetal risks, including an increased risk of sudden fetal demise, primarily due to arrhythmias caused by bile acids affecting the fetal heart. Other risks include meconium staining of amniotic fluid, preterm birth, and NICU admission. Maternal risks include increased chances of gestational diabetes and preeclampsia.
- Ursodeoxycholic acid (UDCA) is the primary treatment, aiming to reduce bile acid levels and improve pruritus. Dosage starts at 10-15 mg/kg/day and may increase, though it doesn't eliminate fetal risks. Topical emollients and antihistamines (like chlorpheniramine) can provide symptomatic relief from itching.
- Fetal monitoring is crucial, though standard ultrasounds and Doppler studies may not prevent stillbirth. Monitoring fetal movements is recommended. Delivery timing depends on severity; mild cases may be delivered near term, while severe cases often warrant earlier delivery (34-37 weeks). Antenatal corticosteroids should be considered if delivery is before 37 weeks.
- Postpartum follow-up is essential to confirm resolution of symptoms and normalization of liver function. Persistent abnormalities necessitate referral to a hepatologist. Recurrence risk in subsequent pregnancies is high (60-90%). Baseline liver function tests should be offered in future pregnancies.
- Regarding contraception, most methods are safe; however, combined oral contraceptive pills are generally avoided due to potential effects on liver function. Progesterone-only methods are typically favored. It is essential to have proper lab follow up.
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