Intrahepatic cholestasis(ICP)ofpregnancy妊娠肝内胆汁郁积症Pruritus occurring in pregnancyin the absence ofdermatologic abnormalities,is usually due to ICP Symptoms(pruritus)usually commence between 28and34weeksIncidence:1-2/1000 pregnancies
Intrahepatic cholestasis of pregnancy （ICP） 妊娠肝内胆汁郁积症 ❖ Pruritus occurring in pregnancy ,in the absence of dermatologic abnormalities,is usually due to ICP ❖ Symptoms(pruritus)usually commence between 28 and 34 weeks Incidence: 1-2/1000 pregnancies
DiagnosisICP should be suspected when widespread pruritus occursin the third trimester.without skin rash.Highlevels of bileacids(5-100 times normal)Bilirubin appears in the urine.(in most ),alkaline phosphatase and bilirubin be elevated.transaminases is elevated (in many)fordifferential diagnosis,hepatitis serology,hepatobiliarytract ultrasonoguaphy and autoantibodies screan should beperformed in all cases.(ultrasonography is very important toexclude abstruction of the biliary tree.)
ICP should be suspected when widespread pruritus occurs in the third trimester. without skin rash. High levels of bile acids(5-100 times normal) Bilirubin appears in the urine. (in most ),alkaline phosphatase and bilirubin be elevated. transaminases is elevated (in many) for differential diagnosis ,hepatitis serology ,hepatobiliary tract ultrasonoguaphy and autoantibodies screan should be performed in all cases.(ultrasonography is very important to exclude abstruction of the biliary tree.) Diagnosis
Maternal/FetalRisksFor the motherit carries a 10-22% risk ofobstetric Hemorrhage,and preterm labor.For the fetal prognosis,stillbirth(up to 15%),Preterm delivery (up to 30%),fetal distress(up to 25%),and meconium staining of the amniotic fluid(30-40%),The mechanism of fetal compromise is uncertain
❖ For the mother,it carries a 10-22% risk of obstetric Hemorrhage,and preterm labor. ❖ For the fetal prognosis,stillbirth(up to 15%), Preterm delivery (up to 30%), fetal distress(up to 25%), and meconium staining of the amniotic fluid (30-40%), The mechanism of fetal compromise is uncertain. Maternal/Fetal Risks
ManagementPrenatal monitoring of fetal well being;timing of delivary;maternal symptom control;vitamin K supplementation.intramuscular Vit.K 10mg weekly should be given from 36 weeksIntrapartumVitaminK 1Omg is given to mother;The newborn body should receive VitaminK(there is evidence of a bleeding tendency)Postnatal Biliary tract ultrasonography (for stones),(if pruritus does not disapear>7-10 days after delivery.)In occasional case where abnormalities do not resolveafter delivery liver biopsy may need consideration
Prenatal monitoring of fetal well being; timing of delivary; maternal symptom control; vitamin K supplementation. intramuscular Vit.K 10mg weekly should be given from 36 weeks. Intrapartum Vitamin K 10mg is given to mother; The newborn body should receive Vitamin K (there is evidence of a bleeding tendency). Postnatal Biliary tract ultrasonography (for stones), (if pruritus does not disapear >7-10 days after delivery.) In occasional case where abnormalities do not resolve after delivery ,liver biopsy may need consideration. Management
Medical and SurgicalComplications duringPregnancyChronic Glomerulonephritis慢性肾小球肾炎AndPyelonephritis
Medical and Surgical Complications during Pregnancy Chronic Glomerulonephritis慢性 肾小球肾炎 And Pyelonephritis