Second and third trimesters :
Intrahepatic Cholestasis of Pregnancy:
Continued..
Effects on the Mother:
Discomfort of pruritus.
Increased risk of postpartum hemorrhage, especially in those given cholestyramine.
An increased risk for the development of gallstones after pregnancy.
Effects on the Fetus:
An increased incidence of prematurity and fetal death.
Fetal distress is reported in one third of patients.
These outcomes are more likely if the disorder begins earlier in pregnancy.
Treatment:
Therapy is directed at alleviating pruritus in the mother. Ursodeoxycholic acid in a dose of 20 to 25 mg/kg/day.
Phenobarbital in a dosage of 100 mg/day has been reported to be effective in approximately 50% of patients.
Cholestyramine may be somewhat effective and is usually given in a dosage of 4 g four or five times per day.
Cholestyramine may worsen the malabsorption of fats and fat-soluble vitamins.
Therefore, the prothrombin time must be monitored in patients treated with this regimen, and parenteral vitamin K should be given before delivery.
Intravenous or oral S'-adenosyl-1.-methionine has been reported to lead to a significant improvement in pruritus and in serum transaminase and bilirubin levels, perhaps by reducing the negative effects of estrogens on bile secretion.
Some investigators recommend elective induction at 38 weeks or as early as 36 weeks in the presence of jaundice or if the fetal lungs have matured.
Intrahepatic Cholestasis of Pregnancy:
Continued..
Effects on the Mother:
Discomfort of pruritus.
Increased risk of postpartum hemorrhage, especially in those given cholestyramine.
An increased risk for the development of gallstones after pregnancy.
Effects on the Fetus:
An increased incidence of prematurity and fetal death.
Fetal distress is reported in one third of patients.
These outcomes are more likely if the disorder begins earlier in pregnancy.
Treatment:
Therapy is directed at alleviating pruritus in the mother. Ursodeoxycholic acid in a dose of 20 to 25 mg/kg/day.
Phenobarbital in a dosage of 100 mg/day has been reported to be effective in approximately 50% of patients.
Cholestyramine may be somewhat effective and is usually given in a dosage of 4 g four or five times per day.
Cholestyramine may worsen the malabsorption of fats and fat-soluble vitamins.
Therefore, the prothrombin time must be monitored in patients treated with this regimen, and parenteral vitamin K should be given before delivery.
Intravenous or oral S'-adenosyl-1.-methionine has been reported to lead to a significant improvement in pruritus and in serum transaminase and bilirubin levels, perhaps by reducing the negative effects of estrogens on bile secretion.
Some investigators recommend elective induction at 38 weeks or as early as 36 weeks in the presence of jaundice or if the fetal lungs have matured.
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