Cholestasis of pregnancy: Difference between revisions
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==Background== | ==Background== | ||
* | *Caused by combination of hormonal, genetic, and environmental factors --> impaired bile flow --> deposition of bile salts in skin and placenta | ||
*May predispose mothers to [[vitamin K deficiency]] and increase risk of preterm delivery, [[IUFD]], and neonatal [[respiratory distress syndrome]]<ref>http://bestpractice.bmj.com/topics/en-us/800</ref> | |||
==Clinical Features== | ==Clinical Features== | ||
* | *Typically develops in late second and/or 3rd trimester | ||
*RUQ | *Rapidly resolves after delivery | ||
*Nausea | *[[Pruritus]], starts and predominates on palms and soles | ||
*Jaundice | *[[RUQ pain]] | ||
*[[Nausea]] | |||
*[[Jaundice]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Liver disease in pregnancy | *Liver disease in pregnancy: | ||
** | **Acute fatty liver of pregnancy | ||
**hemolysis, elevated liver enzymes and low platelets syndrome | **[[HELLP]] (hemolysis, elevated liver enzymes, and low platelets) syndrome | ||
** | **[[Hyperemesis gravidarum]] | ||
*Pregnancy specific pruritus | *Pregnancy-specific pruritus (see also: [[Rashes of pregnancy]]) | ||
**Pruritus gravidarum | **Pruritus gravidarum | ||
**Atopic eruption of pregnancy | **Atopic eruption of pregnancy | ||
**Polymorphic eruption of pregnancy | **Polymorphic eruption of pregnancy | ||
**Pemphigoid | **Pemphigoid gestationis | ||
**Prurigo of pregnancy | **Prurigo of pregnancy | ||
**Pruritic folliculitis of pregnancy | **Pruritic folliculitis of pregnancy | ||
==Evaluation== | ==Evaluation== | ||
* | *CBC (rule out thrombocytopenia) | ||
* | *[[LFTs]] | ||
* | **Elevated total bile acid concentration | ||
*GGT | **Aminotransferases usually <2x upper limit of normal | ||
*US | **Alk phos and bili may be elevated | ||
**GGT normal or modestly elevated | |||
**[[RUQ US]] normal, no biliary duct dilation | |||
==Management== | ==Management== | ||
*Ursodeoxycholic acid 300mg TID until delivery | *Ursodeoxycholic acid ([[ursodiol]]) 300mg TID until delivery | ||
*OBGYN follow-up | *OBGYN follow-up | ||
==Disposition== | ==Disposition== | ||
* | *Discharge with OBGYN follow-up | ||
==See Also== | ==See Also== | ||
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https://www.uptodate.com/contents/intrahepatic-cholestasis-of-pregnancy | https://www.uptodate.com/contents/intrahepatic-cholestasis-of-pregnancy | ||
<references/> | <references/> | ||
[[Category:OBGYN]] [[Category:GI]] | |||
Revision as of 19:56, 21 August 2019
Background
- Caused by combination of hormonal, genetic, and environmental factors --> impaired bile flow --> deposition of bile salts in skin and placenta
- May predispose mothers to vitamin K deficiency and increase risk of preterm delivery, IUFD, and neonatal respiratory distress syndrome[1]
Clinical Features
- Typically develops in late second and/or 3rd trimester
- Rapidly resolves after delivery
- Pruritus, starts and predominates on palms and soles
- RUQ pain
- Nausea
- Jaundice
Differential Diagnosis
- Liver disease in pregnancy:
- Acute fatty liver of pregnancy
- HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome
- Hyperemesis gravidarum
- Pregnancy-specific pruritus (see also: Rashes of pregnancy)
- Pruritus gravidarum
- Atopic eruption of pregnancy
- Polymorphic eruption of pregnancy
- Pemphigoid gestationis
- Prurigo of pregnancy
- Pruritic folliculitis of pregnancy
Evaluation
- CBC (rule out thrombocytopenia)
- LFTs
- Elevated total bile acid concentration
- Aminotransferases usually <2x upper limit of normal
- Alk phos and bili may be elevated
- GGT normal or modestly elevated
- RUQ US normal, no biliary duct dilation
Management
- Ursodeoxycholic acid (ursodiol) 300mg TID until delivery
- OBGYN follow-up
Disposition
- Discharge with OBGYN follow-up
See Also
External Links
References
https://www.uptodate.com/contents/intrahepatic-cholestasis-of-pregnancy