Second and third trimesters :
Intrahepatic Cholestasis of Pregnancy:
The syndrome has been variously called recurrent jaundice of pregnancy, cholestatic jaundice of pregnancy, jaundice of late pregnancy and hepatosis of pregnancy.
ICP, however is the preferred term, because jaundice is inconstant in any type of cholestatic disorder.
The frequency of ICP is clearly higher among certain ethnic groups, including Scandinavians and Chileans.
In the latter group, ICP may appear in 2.4% or more of pregnancies, the highest reported incidence in the world.
The incidence is quite high (20.9%) in twin pregnancies.
Several studies have demonstrated a familial and genetic predisposition to the syndrome in Sweden, Chile, and the United States.
Clinical Description:
Pruritus is the dominant and initial symptom and appears in the third trimester in more than 70% of cases.
Usually involves the trunk and the extremities, including the palms and the soles of the feet.
As a result of the pruritus, insomnia, fatigue, and even mental disturbances have been reported. Many patients report the appearance of dark urine without frank jaundice shortly after the onset of pruritus.
Only a minority of patients develop obvious jaundice and this is usually mild.
It is notable that abdominal pain, biliary colic, fever, anorexia, nausea, vomiting and arthralgias are absent.
The improvement in both pruritus and jaundice begins to occur quite promptly after delivery, most often within 24 hours.
However, jaundice may continue for several days after delivery. Subsequent pregnancies are frequently accompanied by recurrences of the syndrome.
Biochemical Changes: increase noted in
Serum bile acid : 10-to 100 folds
Alkaline Phosphatase : 7- to 10 folds 5' Nucleotidase : Two Folds
GGTP : Normal to slight
Bilirubin (total) : Normal to 5 mg/dl
AST/ALT : Two fold
Prothrombin time : Normal to twofolds
Cholesterol : Two to Four folds
Triglyceride : Normal to two folds
Intrahepatic Cholestasis of Pregnancy:
The syndrome has been variously called recurrent jaundice of pregnancy, cholestatic jaundice of pregnancy, jaundice of late pregnancy and hepatosis of pregnancy.
ICP, however is the preferred term, because jaundice is inconstant in any type of cholestatic disorder.
The frequency of ICP is clearly higher among certain ethnic groups, including Scandinavians and Chileans.
In the latter group, ICP may appear in 2.4% or more of pregnancies, the highest reported incidence in the world.
The incidence is quite high (20.9%) in twin pregnancies.
Several studies have demonstrated a familial and genetic predisposition to the syndrome in Sweden, Chile, and the United States.
Clinical Description:
Pruritus is the dominant and initial symptom and appears in the third trimester in more than 70% of cases.
Usually involves the trunk and the extremities, including the palms and the soles of the feet.
As a result of the pruritus, insomnia, fatigue, and even mental disturbances have been reported. Many patients report the appearance of dark urine without frank jaundice shortly after the onset of pruritus.
Only a minority of patients develop obvious jaundice and this is usually mild.
It is notable that abdominal pain, biliary colic, fever, anorexia, nausea, vomiting and arthralgias are absent.
The improvement in both pruritus and jaundice begins to occur quite promptly after delivery, most often within 24 hours.
However, jaundice may continue for several days after delivery. Subsequent pregnancies are frequently accompanied by recurrences of the syndrome.
Biochemical Changes: increase noted in
Serum bile acid : 10-to 100 folds
Alkaline Phosphatase : 7- to 10 folds 5' Nucleotidase : Two Folds
GGTP : Normal to slight
Bilirubin (total) : Normal to 5 mg/dl
AST/ALT : Two fold
Prothrombin time : Normal to twofolds
Cholesterol : Two to Four folds
Triglyceride : Normal to two folds
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