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By Chad Klauser Maternal Fetal Medicine physician in NYC
Tetsuya Kawakita, Laura I Parikh, Patrick S Ramsey, Chun-Chih Huang, Alexander Zeymo, Miguel Fernandez, Samuel Smith, Sara N Iqbal
OBJECTIVE: We sought to determine predictors of adverse neonatal outcomes in women with intrahepatic cholestasis of pregnancy (ICP). STUDY DESIGN: This study was a multicenter retrospective cohort study of all women diagnosed with ICP across 5 hospital facilities from January 2009 through December 2014. Obstetric and neonatal complications were evaluated according to total bile acid (TBA) level. Multivariable logistic regression models were developed to evaluate predictors of composite neonatal outcome (neonatal intensive care unit admission, hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, transient tachypnea of the newborn, mechanical ventilation use, oxygen by nasal cannula, pneumonia, and stillbirth)...
October 2015: American Journal of Obstetrics and Gynecology
Sebiha Ozkan, Yasin Ceylan, Orhan Veli Ozkan, Sule Yildirim
Intrahepatic cholestasis of pregnancy (ICP) is a reversible pregnancy-specific cholestatic condition characterized by pruritus, elevated liver enzymes, and increased serum bile acids. It commences usually in the late second or third trimester, and quickly resolves after delivery. The incidence is higher in South American and Scandinavian countries (9.2%-15.6% and 1.5%, respectively) than in Europe (0.1%-0.2%). The etiology is multifactorial where genetic, endocrine, and environmental factors interact. Maternal outcome is usually benign, whereas fetal complications such as preterm labor, meconium staining, fetal distress, and sudden intrauterine fetal demise not infrequently lead to considerable perinatal morbidity and mortality...
June 21, 2015: World Journal of Gastroenterology: WJG
Jin Jin, Shi-lei Pan, Li-ping Huang, Yan-hong Yu, Mei Zhong, Guo-wei Zhang
OBJECTIVE: To determine risk factors for adverse fetal outcomes (AFOs) among women with intrahepatic cholestasis of pregnancy (ICP) on the basis of time of onset. METHODS: In a retrospective analysis, data were obtained for all women with ICP admitted to two centers in Guangzhou, China, between February 1, 1993, and January 31, 2014. Patients were divided into group A (early-onset ICP) and group B (late-onset ICP), and were further divided on the basis of severity...
March 2015: International Journal of Gynaecology and Obstetrics
Marcus G Martineau, Christina Raker, Peter H Dixon, Jenny Chambers, Mavis Machirori, Nicole M King, Melissa L Hooks, Ramya Manoharan, Kenneth Chen, Raymond Powrie, Catherine Williamson
OBJECTIVE: Quantification of changes in glucose and lipid concentrations in women with intrahepatic cholestasis of pregnancy (ICP) and uncomplicated pregnancy and study of their influence on fetal growth. RESEARCH DESIGN AND METHODS: A prospective study comparing metabolic outcomes in cholestastic and uncomplicated singleton pregnancies was undertaken at two university hospitals in the U.K. and U.S. from 2011-2014. A total of 26 women with ICP and 27 control pregnancies with no prior history of gestational diabetes mellitus were recruited from outpatient antenatal services and followed until delivery...
February 2015: Diabetes Care
Jamie O Lo, Brian L Shaffer, Allison J Allen, Sarah E Little, Yvonne W Cheng, Aaron B Caughey
OBJECTIVE: We examined the morbidities from delivery at earlier gestational ages versus intrauterine fetal demise (IUFD) for women with intrahepatic cholestasis of pregnancy (ICP) to determine the optimal gestational age for delivery. METHODS: A decision-analytic model was created to compare delivery at 35 through 38 weeks gestation for different delivery strategies: (1) empiric steroids; (2) steroids if fetal lung maturity (FLM) negative; (3) wait a week and retest if FLM negative; or (4) deliver immediately...
2015: Journal of Maternal-fetal & Neonatal Medicine
Sophie Grand'Maison, Madeleine Durand, Michèle Mahone
OBJECTIVE: The benefits of ursodeoxycholic acid (UDCA) use for treating intra-hepatic cholestasis of pregnancy (ICP) remain uncertain. A 2010 Cochrane Review of randomized control trials was unable to recommend either for or against the use of UDCA in treating ICP. We conducted a meta-analysis of the literature, including both non-randomized studies (NRSs) and RCTs. The objective of the study was to determine if patients included in NRSs were comparable to those in RCTs, and to determine whether the inclusion of NRSs could strengthen the available evidence and guide clinical practice on UDCA use in women with ICP...
July 2014: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
Patrik Šimják, Antonín Pařízek, Libor Vítek, Andrej Černý, Karolína Adamcová, Michal Koucký, Martin Hill, Michaela Dušková, L'uboslav Stárka
Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disorder of pregnancy. Diagnosis is based on the clinical picture, particularly the presence of pruritus with a deterioration of liver function tests, and typically elevated serum levels of total bile acids. ICP manifests in the second half of pregnancy, predominantly during the third trimester. Symptoms of the disease resolve spontaneously after delivery. Etiology is still not fully understood. Genetic defects in specific transport proteins, elevated levels of sex hormones, and various environmental factors are thought to play a role in the development of this disorder...
March 2015: Journal of Perinatal Medicine
Laura Brouwers, Maria P H Koster, Godelieve C M L Page-Christiaens, Hans Kemperman, Janine Boon, Inge M Evers, Auke Bogte, Martijn A Oudijk
OBJECTIVE: The primary aim of this study was to investigate the correlation between pregnancy outcome and bile acid (BA) levels in pregnancies that were affected by intrahepatic cholestasis of pregnancy (ICP). In addition, correlations between maternal and fetal BA levels were explored. STUDY DESIGN: We conducted a retrospective study that included women with pruritus and BA levels ≥10 μmol/L between January 2005 and August 2012 in 3 large hospitals in the Netherlands...
January 2015: American Journal of Obstetrics and Gynecology
Yun Hu, Yi-Ling Ding, Ling Yu
INTRODUCTION: To investigate the impact of intrahepatic cholestasis of pregnancy (ICP) with hepatitis B virus (HBV) infection on perinatal outcomes. METHODS: In the study, 200 pregnant women were divided into four groups, including 50 cases with ICP and HBV infection, 50 cases with ICP, 50 cases with HBV infection, and 50 healthy pregnancies. The delivery process and perinatal outcomes were analyzed among different groups. RESULTS: When compared to the healthy pregnancy group, significantly increased rates of premature rupture of membranes, meconium-stained amniotic fluid, and cesarean section were observed in cases of ICP, HBV infection, or ICP patients with HBV (P<0...
2014: Therapeutics and Clinical Risk Management
Catherine Williamson, Victoria Geenes
Intrahepatic cholestasis of pregnancy is the most common pregnancy-specific liver disease that typically presents in the third trimester. The clinical features are maternal pruritus in the absence of a rash and deranged liver function tests, including raised serum bile acids. Intrahepatic cholestasis of pregnancy is associated with an increased risk of adverse perinatal outcomes, including spontaneous preterm delivery, meconium staining of the amniotic fluid, and stillbirth. It is commonly treated with ursodeoxycholic acid...
July 2014: Obstetrics and Gynecology
Sangita Ghosh, Soumik Chaudhuri
Intra-hepatic cholestasis of pregnancy is a cholestatic disorder characterized by i) pruritus, with onset in the third trimester of pregnancy, without any primary skin lesions, ii) elevated fasting serum bile acids > 10 μmol/L (and elevated serum transaminases), iii) spontaneous relief of signs and symptoms within two to three weeks after delivery, and iv) absence of other disease that cause pruritus and jaundice. It is believed to be a multi-factorial disease with interplay between genetic, environmental and hormonal factors...
July 2013: Indian Journal of Dermatology
Manuela Martinefski, Mario Contin, Silvia Lucangioli, Maria Beatriz Di Carlo, Valeria Tripodi
Until now, biochemical parameter for diagnosis of intrahepatic cholestasis of pregnancy (ICP) mostly used is the rise of total serum bile acids (TSBA) above the upper normal limit of 11 μM. However, differential diagnosis is very difficult since overlapped values calculated on bile acids determinations, are observed in different conditions of pregnancy including the benign condition of pruritus gravidarum. The aim of this work was to determine the better markers in ICP for a precise diagnosis together with parameters associated with severity of symptoms and treatment evaluation...
2012: Scientifica
Khulood T Ahmed, Ashraf A Almashhrawi, Rubayat N Rahman, Ghassan M Hammoud, Jamal A Ibdah
Pregnancy is a special clinical state with several normal physiological changes that influence body organs including the liver. Liver disease can cause significant morbidity and mortality in both pregnant women and their infants. This review summarizes liver diseases that are unique to pregnancy. We discuss clinical conditions that are seen only in pregnant women and involve the liver; from Hyperemesis Gravidarum that happens in 1 out of 200 pregnancies and Intrahepatic Cholestasis of Pregnancy (0.5%-1.5% prevalence), to the more frequent condition of preeclampsia (10% prevalence) and its severe form; hemolysis, elevated liver enzymes, and a low platelet count syndrome (12% of pregnancies with preeclampsia), to the rare entity of Acute Fatty Liver of Pregnancy (incidence of 1 per 7270 to 13000 deliveries)...
November 21, 2013: World Journal of Gastroenterology: WJG
Rafael González-Blanco, Agueda Sofia Mortara-Gómez, Alfonso Martínez-Uribe, Rosa Arias-Loza, Augusto Sanginés-Martínez
Intrahepatic cholestasis of pregnancy has a prevalence of 1/1000 to 1/10000. Its etiology is multifactorial, involving genetic an hormonal factors, associated with adverse perinatal and obstetric outcomes. Report the case of patient 25 years old, with 32 weeks of gestation, which presents severe pruritus, jaundice, altered liver function tests and lipid profile, with presumptive diagnosis of intrahepatic cholestasis of pregnancy. Making weekly monitoring analytical biochemistry, test of fetal wellbeing, symptomatic management, with abdominal pregnancy termination at 35 weeks, for lack of clinical improvement, increase in metabolic disorders and intrauterine growth restriction, after induction of fetal lung maturity, with good obstetric and perinatal outcome...
November 2013: Ginecología y Obstetricia de México
Serge Erlinger
No abstract text is available yet for this article.
June 2014: Clinics and Research in Hepatology and Gastroenterology
Victoria Geenes, Lucy C Chappell, Paul T Seed, Philip J Steer, Marian Knight, Catherine Williamson
UNLABELLED: Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disease, characterized by maternal pruritus and raised serum bile acids. Our objectives were to describe the epidemiology and pregnancy complications associated with severe ICP and to test the hypothesis that adverse perinatal outcomes are increased in these women. A prospective population-based case-control study with national coverage was undertaken using the UK Obstetric Surveillance System (UKOSS)...
April 2014: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Yannick Bacq, Loïc Sentilhes, Humberto B Reyes, Anna Glantz, Jurate Kondrackiene, Tomas Binder, Pier Luigi Nicastri, Anna Locatelli, Annarosa Floreani, Ismael Hernandez, Vincent Di Martino
BACKGROUND & AIMS: We performed a meta-analysis to evaluate the effects of ursodeoxycholic acid (UDCA) on pruritus, liver test results, and outcomes of babies born to women with intrahepatic cholestasis of pregnancy (ICP). METHODS: We performed a systematic review of 9 published, randomized controlled trials (3 double blinded) that compared the effects of UDCA to other drugs, placebo, or no specific treatment (controls) in patients with ICP. We analyzed data from 454 patients: 207 received only UDCA, 70 received only placebo, 42 received cholestyramine, 36 received dexamethasone for 1 week and then placebo for 2 weeks, 65 received S-adenosyl-methionine, and 34 received no specific treatment...
December 2012: Gastroenterology
Cassandra E Henderson, Reena R Shah, Sri Gottimukkala, Khaldun K Ferreira, Abraham Hamaoui, Ray Mercado
The Royal College of Obstetrics and Gynecology does not endorse routine active management of intrahepatic cholestasis of pregnancy (ICP)-affected pregnancies. In contrast, the American College of Obstetricians and Gynecologists supports active management protocols for ICP. To investigate this controversy, we evaluated the evidence supporting ICP as a medical indication for early term delivery and the evolution of active management protocols for ICP. Sixteen articles published between 1986 and 2011 were identified...
September 2014: American Journal of Obstetrics and Gynecology
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