Materiały źródłowe

• #1 Intrahepatic cholestasis of pregnancy: Diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6448735/

  Intrahepatic cholestasis of pregnancy (ICP) is a liver disease unique to pregnancy. It is characterized by pruritus associated with elevated serum bile acids and/or aminotransferase levels. ICP usually manifests during the second or third trimester of pregnancy and spontaneously improves after delivery. Diagnosis of ICP is usually based on pruritus occurring during pregnancy that is associated with elevated serum aminotransferase and/or serum bile acids, after other causes of liver test abnormalities have been excluded. […] Measurement of aminotransferase activity, especially alanine aminotransferase (ALT), provides a very sensitive test for the diagnosis of ICP. […] The serum bile acid concentrations also are usually elevated, and the cutoff values chosen for diagnosis of ICP are usually values of more than 10 mol/L. Normal bile acid concentrations do not exclude the diagnosis.

• #1 Intrahepatic cholestasis of pregnancy: Diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6448735/

  In some patients with ICP, pruritus may precede liver test abnormalities. […] Liver biopsy is rarely necessary for the diagnosis of ICP; however, if it is carried out, the histopathology is characterized by pure cholestasis, with bile plugs sometimes visible in the hepatocytes and canaliculi. […] Patients should be followed after delivery to ensure resolution of pruritus and to carry out blood tests (liver function tests and bile acids, if available).

• #2 Cholestasis Of Pregnancy: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17901-cholestasis-of-pregnancy

  Cholestasis of pregnancy is a liver disease that can develop late in pregnancy. Cholestasis of pregnancy typically goes away after your baby is born. […] Cholestasis of pregnancy is a liver condition that causes severe itching late in pregnancy. Its also known as intrahepatic cholestasis of pregnancy (ICP) or obstetric cholestasis. […] ICP temporarily lowers liver function in some pregnant women. This causes bile to build up in your liver and bloodstream. […] Cholestasis of pregnancy can cause complications for you and the fetus. To lower the risk of complications, your pregnancy care provider may monitor you closely for the remainder of your pregnancy. […] Your pregnancy care provider diagnoses cholestasis of pregnancy during a physical examination and blood test. These tests tell your provider how your liver is functioning.

• #3 Pregnancy Intrahepatic Cholestasis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK551503/

  Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disorder in pregnancy and is associated with an increased risk of adverse obstetrical outcomes like sudden fetal demise. […] This activity describes the pathophysiology, evaluation, and treatment of ICP, and highlights the role of the interprofessional team in evaluating and managing affected patients. […] Outline how to diagnose intrahepatic cholestasis of pregnancy. […] The diagnosis of intrahepatic cholestasis of pregnancy (ICP) is via the presence of clinical symptom that is pruritus in the third trimester with elevated maternal total serum bile acids and excluding other diagnoses, which can cause similar symptoms and lab abnormalities. […] The most sensitive and specific marker for ICP is the total serum bile acid (91 and 93 percent) using a cut-off value of 10 micromol/L.

• #3 Pregnancy Intrahepatic Cholestasis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK551503/

  In patients with intrahepatic cholestasis of pregnancy, the importance of regular antepartum fetal testing is not proven to be useful to identify fetuses at risk of demise. […] Many authors have advocated elective early delivery of women with intrahepatic cholestasis of pregnancy to reduce the risk of sudden fetal demise. […] Intrahepatic cholestasis of pregnancy is not an indication for cesarean delivery. […] Postpartum monitoring and follow-up of bile acids and liver function tests should be done in 4-6 weeks to ensure resolution.

• #4 Diagnosis of Intrahepatic Cholestasis of Pregnancy (ICP) – ICP Care

  https://icpcare.org/intrahepatic-cholestasis-pregnancy/diagnosis/

  Diagnosis is based on symptoms and a Total bile acid test. […] Cholestasis of pregnancy is diagnosed based upon symptoms and elevated Total bile acids on blood work. Your doctor will rule out other causes of liver dysfunction, as in some patients there is an underlying cause to the elevated bile acids. […] Serum bile acid testing is the most accurate way to diagnose intrahepatic cholestasis of pregnancy. […] Bile acids over 10 μmol/L indicate ICP. […] Normal bile acids do not rule out an eventual diagnosis of Intrahepatic Cholestasis of Pregnancy. […] Bile acid levels should also be followed in pregnancy even after diagnosis. […] When bile acid testing is not available, diagnosis should be based on symptoms. […] A normal liver function panel does not rule out the disorder as bile acid testing still needs to be performed. […] You may need to provide information to your physician for proper diagnosis.

• #5 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Diagnosis-of-intrahepatic-cholestasis-of-pregnancy-(ICP).aspx

  Women who develop obstetric cholestasis (also known as intrahepatic cholestasis of pregnancy) manifest with symptoms of intense itching. […] However, it is important to diagnose the condition since ICP may lead to harmful effects in the baby. This includes fetal distress at labor (derangements of fetal vital parameters increasing risk of new born complications and death), premature birth (birth before the due date leading to a decreased chances of survival) and even still birth and fetal death. […] Diagnosis and initial assessment includes asking questions about previous history of ICP, ruling out other conditions and so forth. […] All women who have had a previous history of obstetric cholestasis in a previous pregnancy need to be evaluated for ICP carefully in subsequent pregnancies.

• #5 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Diagnosis-of-intrahepatic-cholestasis-of-pregnancy-(ICP).aspx

  Causes of liver dysfunction apart from ICP including gallstones, hepatitis, viral infections with Epstein Barr virus, cytomegalovirus, hepatitis A, B, C or E, side effects of medications, preeclampsia (high blood pressure and complications of pregnancy) and fatty liver disease of pregnancy need to be rule out before diagnosing ICP. […] An initial test is a routine blood test. This also includes the liver function test. […] The LFT should be monitored weekly in suspected cases of ICP. […] Coagulation studies may be prescribed if abnormal LFTs are seen. […] An ultrasound scan of the liver may be prescribed. […] Fetal surveillance is performed to check for the fetal wellbeing. […] Visits to the doctor or antenatal visits are schedules every second week in suspected cases.

• #6 Cholestasis of Pregnancy: Causes, Symptoms & Treatment

  https://americanpregnancy.org/healthy-pregnancy/pregnancy-complications/cholestasis-of-pregnancy/

  Some women experience a very severe itching in late pregnancy. The most common cause of this is cholestasis, a common liver disease that only happens in pregnancy. Intrahepatic Cholestasis of Pregnancy (ICP) is a condition in which the normal flow of bile is affected by the increased amounts of pregnancy hormones. […] Cholestasis is sometimes referred to as extrahepatic cholestasis which occurs outside the liver, intrahepatic cholestasis which occurs inside the liver, or obstetric cholestasis. […] A diagnosis of cholestasis can be made by doing a complete medical history, physical examination, and blood tests that evaluate liver function, bile acids, and bilirubin. The Society for Maternal-Fetal Medicine concurs that cholestasis of pregnancy should be diagnosed when the total bile acids (TBA) or serum bile acids are measured at 10 micromol/L and above.

• #7 Intrahepatic Cholestasis of Pregnancy Workup: Laboratory Studies, Procedures

  https://emedicine.medscape.com/article/1562288-workup

  Jaundice may occur in 17-75% of cases of intrahepatic cholestasis of pregnancy (ICP) but typically develops 1-4 weeks after the onset of pruritus. […] The most specific and sensitive marker of ICP is total serum bile acid (BA) levels greater than 10 micromol/L. […] Guidelines from the Royal College of Obstetricians and Gynaecologists require a pregnancy-specific elevated BA level of 19 mol/L or higher for diagnosis of ICP. […] However, according to the Society for Maternal-Fetal Medicine, any increase in BA levels above the upper limit of normal in a pregnant patient with pruritus supports the diagnosis of ICP. […] Diagnosis of ICP may thus be made in the presence of pruritus without a rash in the absence of other liver disease in a gravid patient beyond 25 weeks gestation with the elevation of serum BA and/or aminotransferases levels. […] A study by Kremer et al reported that increased serum autotaxin activity represents a highly sensitive, specific and robust diagnostic marker of ICP and can distinguish ICP from other pruritic disorders of pregnancy and pregnancy-related liver diseases.

• #8 Intrahepatic Cholestasis of Pregnancy

  https://liverfoundation.org/liver-diseases/complications-of-liver-disease/intrahepatic-cholestasis-of-pregnancy-icp/

  Intrahepatic Cholestasis of Pregnancy (ICP) is a liver disorder which occurs during pregnancy. This condition affects the normal flow of bile. Bile acids are chemicals in the bile of the liver that help with digestion. With ICP the bile flow begins to slow down and the bile acids build up in the blood. This results in the woman itching that can vary in severity and type. The itching can be bothersome to severe itching and is often worse at night. There is rarely jaundice when experiencing this condition. Although it has been reported as early as 5 weeks pregnant, it is more common for it to begin in the third trimester, when hormone concentrations are at their highest levels. The figure for the percentage of women for whom Intrahepatic Cholestasis of Pregnancy will recur in future pregnancies is 60% or as high as 90% for severe ICP.

• #8 Intrahepatic Cholestasis of Pregnancy

  https://liverfoundation.org/liver-diseases/complications-of-liver-disease/intrahepatic-cholestasis-of-pregnancy-icp/

  Intrahepatic Cholestasis of Pregnancy is a condition in which the normal flow of bile is affected by the increased amounts of pregnancy hormones. Cholestasis is more common in the last trimester of pregnancy when hormones are at their peak. Cholestasis occurs in about 1 out of 1,000 pregnancies but is more common in Swedish and Chilean ethnic groups. […] Overall, 1 to 2 pregnancies in 1,000 is affected by ICP in the USA with Latina populations at 5.6%. Risk is increased in women carrying multiples, women who have had IVF treatment and those who have had previous liver damage or issues. The incidence of ICP also shows a striking geographical pattern, with a higher prevalence in Scandinavia and South America specifically Chile where the reported prevalence is as high as 15.6%. Mothers and sisters of patients are also at higher risk of developing the condition, proving that there is a definite genetic predisposition.

• #8 Intrahepatic Cholestasis of Pregnancy

  https://liverfoundation.org/liver-diseases/complications-of-liver-disease/intrahepatic-cholestasis-of-pregnancy-icp/

  ICP poses several risks that are of great concern. It is associated with an increased risk of stillbirth (intrauterine fetal demise), premature labor, respiratory distress in the neonate, meconium staining, preeclampsia and gestational diabetes. […] Cholestasis increases the risk for Respiratory Distress Syndrome after birth (RDS). The elevated bile acids are thought to interfere with the formation of a chemical called surfactant which allows the lungs to expand after birth. There is an increased risk of an infant needing respiratory support after birth. […] ICP has been associated with a substantial rate of preterm birth. There is an increased risk of spontaneous preterm labor, which has been seen in as many as 60% of deliveries in some studies, however with active management most studies report rates of 30%-40%. Earlier presentations of Intrahepatic Cholestasis of Pregnancy (ICP) seem to carry an even greater risk of preterm labor, as well as twin or triplet pregnancies.

• #9 Cholestasis of pregnancy – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cholestasis-of-pregnancy/diagnosis-treatment/drc-20363258

  To diagnose cholestasis of pregnancy, your pregnancy care provider usually will: […] Order blood tests to measure the level of bile acids in your blood and to check how well your liver is working. […] Cholestasis of pregnancy can potentially cause complications to your pregnancy. Your pregnancy care provider may recommend close monitoring of your baby while you’re pregnant. […] While the results of these tests can be reassuring, they can’t predict the risk of preterm birth or other complications associated with cholestasis of pregnancy. […] Even if prenatal tests are within standard limits, your pregnancy care provider may suggest inducing labor before your due date. […] Work with your pregnancy care provider to make sure that you and your baby receive the best possible care for this condition.

• #10 Diagnostic Testing for Cholestasis of Pregnancy – ICP Care

  https://icpcare.org/intrahepatic-cholestasis-pregnancy/diagnostic-testing/

  Intrahepatic Cholestasis of Pregnancy is diagnosed by bloodwork. The test that is used is a “Total Bile Acid” test. Liver function tests are also usually run (AST, ALT) but these are not diagnostic of cholestasis and the bile acid test must be run for diagnosis. […] Studies comparing women with Intrahepatic Cholestasis of Pregnancy to pregnant women without cholestasis have found that a level of 10 μmol/L is usually diagnostic for ICP. Most women with normal pregnancies had bile acids below this level and most women with Intrahepatic Cholestasis (ICP) had levels above this level. SMFM which is the governing board for High Risk OB physicians in the US states that above 10 is diagnostic of cholestasis of pregnancy. […] You do not have to have a specific type of bile acid test run in pregnancy. There is often confusion that you can only have the pregnancy bile acid test from Quest. This is incorrect. Any of these total bile acid tests can be used to diagnose ICP. In fact, studies have verified that many different tests are accurate for diagnosis.

• #11 Diagnosis — ICP Support

  https://www.icpsupport.org/diagnosis

  There is no routine screening for ICP. […] To make the diagnosis of ICP, other liver conditions and causes of itching may need to be ruled out first. […] Research and anecdotal (personal reporting) evidence has shown that some women may itch for several weeks (up to 15 weeks) before their blood tests show any abnormalities. It is therefore important that you continue to have these tests if your bile acids are normal but you continue to itch. […] A non-fasting bile acid test is the most specific test for ICP and most experts in ICP will not confirm a diagnosis of ICP unless this is raised. […] The good news is that there is no association between stillbirth and raised liver enzymes in ICP alone. […] Research has shown that aminotransferases sometimes rise before the bile acids. […] In ICP the bile flow may be slower than usual (meaning there is cholestasis, indicated by raised bile acid concentrations), but it is still doing everything it needs to do to keep you alive. […] The most recent research (Mitchell et al, 2021) demonstrated that the bile acid threshold for diagnosing ICP should actually be 19 mol/L.

• #12 Diagnostic and therapeutic approach for cholestasis in the adult

  http://www.scielo.org.co/scielo.php?pid=S0120-99572020000100076&script=sci_arttext&tlng=en

  Cholestasis is one of the most frequent reasons for hepatology consultation. […] The diagnostic approach involves establishment of the reasons for elevated enzyme levels and determination of whether it is intrahepatic or extrahepatic. […] If it is intrahepatic, the source must be determined (hepatocytes, small bile ducts, or large caliber bile ducts). […] This review presents the pathophysiology and a diagnostic and therapeutic approach. […] The most sensitive test for identifying cholestasis is measurement of serum bile acids, but it is frequently not available. […] When it is not, tests for alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) levels, which are biochemical markers of chronic cholestasis, should be used. […] The first step in studying cholestasis is measurement of ALP.

• #12 Diagnostic and therapeutic approach for cholestasis in the adult

  http://www.scielo.org.co/scielo.php?pid=S0120-99572020000100076&script=sci_arttext&tlng=en

  The approach to cholestasis starts with a physical examination and the medical history. […] The medical history also should cover all drugs, medications, herbal remedies and alcohol consumption, any of which could cause this condition. […] Diagnostic images can be used to determine whether cholestasis is of intrahepatic or extrahepatic origin. […] Abdominal ultrasound is essential for excluding extrahepatic biliary obstruction. […] Other complementary studies of the bile duct include abdominal CT scans, although they do not adequately delineate the bile duct, magnetic resonance cholangiography, endoscopic ultrasound, and endoscopic retrograde cholangiopancreatography. […] Intrahepatic cholestasis of pregnancy occurs in women who are heterozygous for MDR3 deficiency. […] It manifests with pruritus and serum bile acid levels over 40 mmol/L and is associated with a high rate of fetal complications. […] Symptoms spontaneously resolve four to six weeks after delivery.

• #13 Intrahepatic Cholestasis of Pregnancy: New Diagnostic Insights | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-intrahepatic-cholestasis-pregnancy-new-diagnostic-S1665268119303771

  Intrahepatic Cholestasis of Pregnancy (ICP) is the most common pregnancy-related liver disease and is characterized by onset of pruritus and elevated serum transaminases and bile acids (BA) in the third trimester of pregnancy. […] Genetic defects of canalicular transporters have been associated with the development of ICP, which may be further influenced by gestational hormones. […] Patients are classified as mild (BA 10-40) or severe (BA 40) which has implications with respect to the risk of perinatal complications. […] While the mechanisms resulting in fetal complications remain incompletely understood, studies suggest that elevated bile acid levels in the circulation play a significant role. […] In two recently published studies from China, additional risk factors for fetal complications were found to be early-onset ICP and concomitant hepatitis B infection.

• #13 Intrahepatic Cholestasis of Pregnancy: New Diagnostic Insights | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-intrahepatic-cholestasis-pregnancy-new-diagnostic-S1665268119303771

  Classification of disease severity has helped to determine the risk of fetal complications in patients with ICP. […] Serum total bile acid levels were not reported in regards to fetal complication rate in this study, which is unfortunate as elevated serum BA are not only a marker of disease but also likely play an important role in its pathogenesis. […] The authors do not discuss treatment strategies in the management of their patients with mild or severe ICP. […] However, despite this study’s limitations, the finding of elevated MMP-2 and MMP-9 in ICP is novel and intriguing and suggests that further investigation to examine these questions may provide important new insights for diagnosis and management of these patients in the future.

• #13 Intrahepatic Cholestasis of Pregnancy: New Diagnostic Insights | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-intrahepatic-cholestasis-pregnancy-new-diagnostic-S1665268119303771

  Interestingly, women who have an episode of ICP, despite post-delivery resolution of symptoms, are at increased risk for development of various hepatobiliary disorders later in life and require appropriate long-term follow up. […] The present study was designed to identify novel serum biomarkers in these women. […] The authors followed a cohort of 98 patients diagnosed with ICP based on the presence of pruritus, elevated serum transaminases and total serum BA 14 and a control group of 50 healthy pregnant women. […] The impact of population-specific differences in establishing normal ranges of serum total bile acid levels especially as it relates to diagnosis of ICP are clear. […] Prior studies, including a study based in China, evaluating the diagnostic criteria in ICP have found use of serum total bile acid levels superior to ALT and AST, which frequently follow bile acid elevations in the circulation and may represent hepatocellular damage due to cholestasis.

• #14 Intrahepatic Cholestasis of Pregnancy (ICP) | Tommy’sCloseleft-arrowleft-arrowleft-arrowleft-arrowleft-arrowleft-arrowCloseReconfirm cookies choice

  https://www.tommys.org/pregnancy-information/pregnancy-complications/obstetric-cholestasis

  How is ICP diagnosed? […] ICP is diagnosed by excluding other causes of the itching. Your doctor will check your skin to see if the itching could be due to a skin condition, like eczema. You might have more than one condition. Your doctor will probably advise you to have some blood tests, including tests to check your liver function and bile acids. […] Some people may have itching for days or weeks before their blood tests become abnormal. If you are still itching and a cause hasn’t been found, the blood tests should be repeated every 1–2 weeks.

• #15 Intrahepatic cholestasis of pregnancy (Green-top Guideline No. 43) | RCOG

  https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/intrahepatic-cholestasis-of-pregnancy-green-top-guideline-no-43/

  This guideline summarises the evidence regarding the diagnosis, and the maternal and fetal risks of intrahepatic cholestasis of pregnancy (ICP), previously called obstetric cholestasis. […] It provides guidance regarding the different care options available. […] Areas of uncertainty are highlighted along with recommendations for future research in this field. […] ICP is defined as: mild (peak bile acids 1939 micromol/L), moderate (peak bile acids 4099 micromol/L) and severe (peak bile acids 100 micromol/L or more).

• #16 Intrahepatic cholestasis of pregnancy | RCOG

  https://www.rcog.org.uk/for-the-public/browse-our-patient-information/intrahepatic-cholestasis-of-pregnancy/

  Once you have been diagnosed with ICP, you should be under the care of an obstetrician. […] Your blood tests will usually be repeated after one week and an individualised plan of care will be made for you depending on your circumstances. […] If you are having one baby and your pregnancy has had no other complications, the following recommendations apply to you: Planned birth by the time of your due date (40 weeks) may be considered if your bile acids are raised between 19 and 39 micromol/L. […] Planned birth at 38-39 weeks gestation may be recommended if your bile acid levels are 40-99 micromol/L and if you have no other risk factors. […] Planned birth at 35-36 weeks gestation may be recommended if your bile acid levels are 100 micromol/L or more. […] At your 6-week postnatal check your healthcare professional should make sure that your itching has gone away and arrange blood tests to make sure that your liver blood tests and bile acids have returned to normal.

• #17 Intrahepatic Cholestasis of Pregnancy: New Insights on an Old Issue – Women’s Healthcare

  https://www.npwomenshealthcare.com/intrahepatic-cholestasis-of-pregnancy-new-insights-on-an-old-issue/

  Intrahepatic cholestasis of pregnancy (ICP) is a hepatic disorder that complicates 0.2% to 2% of pregnancies and poses significant risk to the fetus including preterm delivery and stillbirth. […] Diagnosis is made when total bile acids are greater than 10 mol/L. […] An increase in maternal total serum bile acids combined with the symptom of pruritus and the absence of diseases associated with similar laboratory findings, supports the diagnosis of ICP. […] A total serum bile acid level of greater than 10 mol/L is diagnostic. […] New evidence suggests that levels 100 mol/L or greater result in the highest risk for complications. […] The Society of Maternal-Fetal Medicine recommends initiating antepartum surveillance at a gestational age when delivery would be performed in response to abnormal results.

• #17 Intrahepatic Cholestasis of Pregnancy: New Insights on an Old Issue – Women’s Healthcare

  https://www.npwomenshealthcare.com/intrahepatic-cholestasis-of-pregnancy-new-insights-on-an-old-issue/

  Timing of delivery is based on risk stratification guided by serum bile acid concentration and patient presentation. […] Pregnant individuals with total bile acid levels of 100 mol/L or greater should give birth at 36 0/7 weeks. […] Individuals diagnosed with ICP should be counseled on the likelihood of recurrence in subsequent pregnancies, which has been estimated to be up to 90%.

• #18 Intrahepatic cholestasis of pregnancy – Wikipedia

  https://en.wikipedia.org/wiki/Intrahepatic_cholestasis_of_pregnancy

  Other problems with the liver that occur in pregnancy should be considered by the treating clinician. These include preeclampsia, the HELLP syndrome, and acute fatty liver of pregnancy. Furthermore, other causes of hepatitis, like hepatitis viruses, cancer and certain medications, should also be considered.

• #19 Cholestasis: Definition, Symptoms, Treatment, Causes

  https://my.clevelandclinic.org/health/diseases/24554-cholestasis

  Cholestasis of pregnancy (also called obstetric cholestasis) occurs in some people during the third trimester, when estrogen levels are at their highest. High estrogen inhibits bile secretion in your liver. Obstetric cholestasis goes away by itself after you’ve delivered your baby. […] Cholestasis in pregnancy is associated with an increased risk of life-threatening complications for both the mother and the fetus. Risks include preeclampsia, premature birth and stillbirth. […] If you have symptoms of cholestasis, your healthcare provider will begin their investigation by testing a sample of your blood. They’ll look for high levels of bilirubin and bile salts. […] Some causes of cholestasis may require internal exploration to find and fix them. Your healthcare provider may need to explore your bile ducts or take a liver biopsy, a sample of your liver tissue to test in the lab.

• #20 Bile Acids in Intrahepatic Cholestasis of Pregnancy

  https://www.mdpi.com/2075-4418/12/11/2746

  Bile acids in intrahepatic cholestasis of pregnancy (ICP) is the most common, reversible, and closely related to pregnancy condition characterized by elevated levels of bile acids (BAs) in blood serum and an increased risk of adverse perinatal outcomes. […] Although ICP cannot be completely prevented, its early diagnosis and prompt management significantly reduce the risk of fetal complications, the most serious of which is unexpected intrauterine death. It is worth emphasizing that all diagnostics and management of ICP during pregnancy are based on BA levels. Therefore, it is important to standardize the criteria for diagnosis, as well as recommendations for management depending on the level of BAs, which undoubtedly determines the impact on the fetus. […] ICP is diagnosed on the basis of typical clinical symptoms, laboratory abnormalities, and differential diagnosis excluding other causes of skin pruritus and liver dysfunction in the pregnant woman. The disease is not associated with abnormalities detected in imaging owing to the fact that biliary ducts are not dilated and hepatic parenchyma appears normal. Its dominant symptoms are skin pruritus and increased levels of bile acids (BAs) in the blood serum of the pregnant woman.

• #21 Ultrasonographic evaluation of the gallbladder motor function in the diagnosis and prognosis of intrahepatic cholestasis of pregnancy | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-023-06209-w

  Intrahepatic cholestasis of pregnancy (ICP) is characterized by skin pruritus, elevated liver enzymes, and increased serum total bile acids. […] The goal of this study was to explore the gallbladder volume and evaluate the diagnostic and prognostic value of ultrasound in ICP. […] The ICP group had significantly higher gallbladder basal volume (43.491.34 cm3 vs. 26.660.83 cm3, p0.01) and higher ejection fraction compared with the healthy group. […] The ejection fraction higher than 54.55% at 120 min might predict ICP diagnosis with 96.67% sensitivity and 88.33% specificity, and an AUC of 0.9739 (95% CI 0.95210.9956), while the gallbladder volume higher than 12.52 cm3 at 60 min might predict ICP severity with 59.18% sensitivity and 72.73% specificity, and an AUC of 0.7319 (95% CI 0.57870.8852).

• #21 Ultrasonographic evaluation of the gallbladder motor function in the diagnosis and prognosis of intrahepatic cholestasis of pregnancy | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-023-06209-w

  Our results indicate abnormal volume and ejection function of the gallbladder in patients with ICP. The ejection fraction at 120 min can assist in the diagnosis if ICP exists, and the gallbladder volume at 60 min may assess the degree of severity of ICP. […] The diagnosis of ICP was based on pruritus, elevated liver enzymes, and TBA levels10 mol/L. […] The gallbladder volume was increased in ICP patients, and ultrasonographic cholecystographic examination also revealed a sluggish emptying rate of the gallbladder in normal pregnancy. […] The fact that the ejection fraction at 120 min had the greatest AUC of all these markers suggests that it is a more accurate indicator for the diagnosis of ICP. […] The basal gallbladder volume and gallbladder volume at 60 and 180 min significantly differed between the ICP patients in the severe and moderate subgroups.

• #22 Intrahepatic Cholestasis of Pregnancy (ICP): Research Into Life-saving Diagnostics Receives Funding < Yale School of Medicine

  https://medicine.yale.edu/news-article/intrahepatic-cholestasis-of-pregnancy-icp-research-into-life-saving-diagnostics-receives-funding/

  While he was still in the womb, Judd William Gardners life was stolen by intrahepatic cholestasis of pregnancy (ICP), a liver disorder that can occur in the second or third trimester. […] ICP requires careful monitoring of the mothers bile acid levels. If they rise too high, clinicians may need to induce labor to reduce the risk of complications. […] Unfortunately, most hospitals are not equipped to test for ICP. They must send blood samples to outside laboratories, which can delay a diagnosis by precious daysand in some cases, can be too late. […] When clinicians diagnose ICP, the first-line treatment is ursodeoxycholic acid, or UDCA. The medication can lower concentrations of bile acid to safer levels. If this fails, providers may need to induce delivery of the baby. […] Early detection of ICP is essential for protecting the baby. But to test for the condition, most clinicians send blood samples to laboratories outside of the hospital, that use mass spectrometry to measure the levels of specific bile acids. It typically takes three to five days to receive the test results.

• #22 Intrahepatic Cholestasis of Pregnancy (ICP): Research Into Life-saving Diagnostics Receives Funding < Yale School of Medicine

  https://medicine.yale.edu/news-article/intrahepatic-cholestasis-of-pregnancy-icp-research-into-life-saving-diagnostics-receives-funding/

  El-Khourys new grant will fund comprehensive studies that compare mass spectrometry testing and Total Bile Acids. He will also publish all of the existing validation data his laboratory produced when it first implemented the test in 2019. This will be important for providing hard evidence that the diagnostic results of the new assay are as reliable as the gold-standard testing. […] Through this work, El-Khoury also hopes to spread the word about ICP and the importance of rapid testing. The goal of all of this is to raise awareness about intrahepatic cholestasis of pregnancy and provide recommendations to labs, he says. We want them to know there is an alternative test out there that gives results within an hour and is just as useful as mass spectrometry.

• #23 Cholestasis of pregnancy: in need of a more rapid diagnosis | Journal of Perinatology

  https://www.nature.com/articles/7211565

  Although the use of the pruritis scale may help improve our ability to identify women who have cholestasis, more importantly, as clinicians we should insist on the ability to make the formal diagnosis sooner. […] Thus, from a clinical vantage point, we should each encourage our clinical laboratories to facilitate a more rapid determination of bile acid levels. Placing the medical-legal aspects aside, optimizing patient care for women at risk of cholestasis of pregnancy depends on making a more rapid diagnosis.

• #24 Intrahepatic cholestasis of pregnancy – British Liver Trust

  https://britishlivertrust.org.uk/information-and-support/liver-conditions/intrahepatic-cholestasis-pregnancy/

  If you have ICP you should have a blood pressure measurement and a urine dip stick test at each of your check-ups. […] You should contact your maternity care team if you start to have itching again. […] If your test results are normal, this will confirm that your itching was caused by ICP. You will not need any further treatment.

• #25 Intrahepatic cholestasis of pregnancy (ICP) | CUH

  https://www.cuh.nhs.uk/patient-information/intrahepatic-cholestasis-of-pregnancy-icp/

  Sometimes other blood tests are offered to look at other possible causes for abnormal liver tests. This is more likely if the onset of your ICP is early in pregnancy or severe. […] If you have been diagnosed with ICP, we recommend follow-up care at the maternity hospital for the remainder of your pregnancy. […] You will be offered blood tests to check your LFTs and BAs. This is commonly every 1-2 weeks until birth but an individual plan will be recommended. […] If you experience any of the following, please report it to us: […] How can my ICP be managed? […] Unfortunately, there is nothing we can do to reverse your ICP or to improve it. However, there are treatment options available to help you to manage your symptoms. […] Ursodeoxycholic Acid (UCDA): This has been shown to have a beneficial effect in a small number of people to improve itching. It may also be recommended for people with high BA to reduce the chance of preterm birth.

• #25 Intrahepatic cholestasis of pregnancy (ICP) | CUH

  https://www.cuh.nhs.uk/patient-information/intrahepatic-cholestasis-of-pregnancy-icp/

  The timing of birth is advised according to the level of the highest BA you have had during pregnancy. […] For mild ICP (BA 40 micromol/L), birth is usually recommended between 39-40 weeks. […] For moderate ICP (BA 40-99 micromol/L), birth is usually recommended between 38-39 weeks. […] For severe ICP (BA 100 micromol/L), birth is usually recommended between 35-36 weeks to prevent late stillbirth. […] After you have given birth, it is important to ensure you have a further blood test to check your liver function returns to normal. […] There is approximately 80% chance of ICP recurring in future pregnancies.

• #26 Intrahepatic Cholestasis of Pregnancy: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/1562288-overview

  From a maternal viewpoint, the main consideration is intense pruritus, which may become so intolerable that delivery is considered as early as 35-37 weeks. […] The fetal viewpoint is more concerning, as even with modern treatment the risk for fetal demise can range from 2-11%. […] With this risk for sudden fetal death, the dilemma becomes how to monitor and when to deliver. […] Intrauterine fetal demise is also associated with ICP, especially if the total bile acid level is elevated and/or jaundice is present, but it rarely occurs prior to 36 weeks gestation. […] In summary, the current consensus favors twice-weekly nonstress testing with or without Doppler testing and induction at 37 weeks.

• #26 Intrahepatic Cholestasis of Pregnancy: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/1562288-overview

  Intrahepatic cholestasis of pregnancy (ICP) is a reversible type of hormonally influenced cholestasis. It frequently develops in late pregnancy in individuals who are genetically predisposed and is the most common pregnancy-related liver disorder. Approximately 1% of pregnancies in the United States are affected by this condition. ICP has no clear etiology, and it is believed to be a multifactorial disorder with environmental, hormonal, and genetic contributions. […] The diagnosis is based on physical examination and laboratory findings, but, in general, ICP is a diagnosis of exclusion. […] Once the diagnosis of ICP is made, treatment should be initiated immediately. Maternal outcomes for patients diagnosed with ICP are good, with few, if any, long-term sequelae; however, fetal outcomes can be devastating. Thus, early recognition, treatment, and timely delivery are imperative.

• #27 Obstetric Cholestasis. Learn about Obstetric cholestasis

  https://patient.info/doctor/obstetric-cholestasis-pro

  The guidelines of the Royal College of Obstetricians and Gynaecologists include a recommendation to induce premature delivery in ICP-complicated pregnancies in patients with severe biochemical disorders at 37+0 weeks. […] Follow-up should be long enough to ensure a normalisation of LFTs, and it is reasonable to check the LFTs at six weeks.

• #28 Cholestasis of Pregnancy: Diagnosis, Symptoms, Treatment, More

  https://www.healthline.com/health/pregnancy/cholestasis-pregnancy

  Cholestasis of pregnancy is actually a fairly common condition. It affects 1 or 2 per 1,000 pregnancies in the United States. […] If you start itching and have no idea whats causing it, notify your doctor. Youll probably need to visit your doctor and roll up your sleeve, as a physical exam and some blood work will be next on the agenda. […] Blood tests are necessary to gauge your liver function and measure the level of bile salts (or bile acids) in your blood. […] Your doctor might also be interested in checking how well your blood clots. […] If youve ever had cholestasis with a previous pregnancy, youre at risk for developing it again with a future pregnancy. […] The likelihood of a recurrence during a future pregnancy could rise as high as 90 percent for women whove had a severe case of cholestasis during pregnancy. […] Your healthcare team can monitor your liver function and the level of bile acids or bile salts in your bloodstream from the get-go.

• #29 SMFM Recommendations: Intrahepatic Cholestasis of Pregnancy – The ObG Project

  https://www.obgproject.com/2020/12/26/smfm-recommendations-intrahepatic-cholestasis-of-pregnancy/

  SMFM has released a Consult Series entry on Intrahepatic Cholestasis of Pregnancy (ICP), that typically presents in the second and third trimester of pregnancy. It is characterized by pruritus without rash, as well as elevated bile acids. The incidence is 0.3 to 0.5% and varies between populations. The risks are mostly fetal, including prematurity and IUFD. […] Diagnosis: Pruritus, predominantly in palms and feet and usually worse at night; Elevated bile acids >10 micromol/L (although document notes that this threshold is based on limited data); +/- Elevated transaminases; Absence of associated disease with similar symptoms; Jaundice and dark urine are not typically seen in ICP | Consider other liver disorders. […] ICP is characterized by new onset pruritus without rash, and elevated bile acids. […] Risk factors include prior history of ICP and hepatic/biliary disease. […] UDCA is first line for the treatment of maternal symptoms but data has not demonstrated impact on adverse neonatal outcomes. […] Delivery timing depends on bile acids levels and maternal symptoms.

Zobacz więcej