Obstetric Cholestatic jaundice is a multifactorial condition of pregnancy characterised by pruritus in the absence of a skin rash with abnormal liver function tests (LFTs), neither of which has an alternative cause and both of which resolve after birth. Most authorities accept elevations of any of a wide range of LFTs beyond pregnancy-specific limits. Investigations to exclude other causes of pruritus and of abnormal LFTs should be performed.
The clinical importance of Cholestatic Jaundice lies in the potential fetal risks, which may include spontaneous preterm birth, iatrogenic preterm birth and fetal death.There can also be maternal morbidity in association with the intense pruritus and consequent sleep deprivation.
1. Cholestatic jaundice and Vitamin K
Vitamin K should be given to pregnant woman who is suffering from cholestatic jaundice along with Ursodeoxycholic acid (UDCA).
Correct Answer: a) True.
As vitamin K is fat soluble, women with fat malabsorption–especially biliary obstruction or hepatic disease– may be come deficient in vitamin K. For oral administration to prevent vitamin K deficiency in malabsorption syndromes, a water- soluble preparation (menadiol sodium phosphate) must be used with a usual dose of 10mg daily. Women should be advised that where the prothrombin time is prolonged, the use of water- soluble vitamin K in doses of 5–10mg daily is indicated. Ref: RCOG 2014.
2. Diagnosis of Cholestatic Jaundice
Cholestatic Jaundice is diagnosed when otherwise unexplained pruritus occurs in pregnancy and abnormal liver function tests (LFTs) and/or raised bile acids occur in the pregnant woman and both resolve after delivery. Pruritus that involves the palms and soles of the feet is particularly suggestive.
Pregnancy-specific reference ranges for LFTs should be used. Other causes of itching and of liver dysfunction should be excluded. Women with persistent pruritus and normal biochemistry should have LFTs repeated every 1–2 weeks. Postnatal resolution of pruritus and abnormal LFTs should be confirmed.
3. Best marker for Intrahepatic cholestasis of pregnancy is ?
a) Serum Transaminases
c) Bile acids
d) Serum ammonia
e) Alkaline phospatase
Correct Answer: c) Bile acids.
If the ALT level is elevated, this, plus pruritus of palms and soles, could be considered as potentially diagnostic of ICP but only with elevated bile acid levels (however LFTs are not always elevated in ICP patients).
4. Drug of choice for treatment of intrahepatic cholestasis in pregnancy
a) Ursodeoxycholic acid
Correct Answer: a) Ursodeoxycholic acid
(UDCA) improves clinical symptoms and liver parameters in a number of cholestatic liver disorders. Phenobarbital relieves pruritus in 50% of patients but shows no reduction of liver enzymes or bile salts and also have significant adverse effects. Vitamin K deficiency was observed with the use of cholestyramine in high doses. Dexamethasone demonstrated limited benefits in cases of ICP with significant side effects.Prev Next
"Authored By Dr.Niraj Mahajan"
MD- Gynecologist, Laparoscopic Surgeon, Uro-gynecologist , Infertility specialist & Cosmetic Gynecologist.Read more [+]