Ramya V A
Sree Mookambika Institute of Medical Science, IndiaTitle: A scratch won’t stop an itch – Intrahepatic cholestasis in pregnancy
Abstract
Introduction and Importance: Intrahepatic liver disease is a cholestatic liver disease unique to pregnancy. Incidence ranging from 0.2 to 5.6%. It usually presents during the second and third trimester of pregnancy and is clinically defined by an persistent pruritus specially involving the palms and soles and biochemically by elevated serum total bile acid levels and/or abnormal serum liver tests, in the absence of primary skin lesions. It is associated with morbidity and mortality to newborn .Emphasizing the importance of early identification, careful management and counselling.
Case Presentation: A 25-year-old woman, PRIMI at 37weeks of gestation, hypothyroid presented in night with intense itching in palms, soles and abdominal region. Per abdomen uterus corresponding to term, FHR-140/min, relaxed, scratch marks present. With lab investigations reports patient was diagnosed as Intrahepatic cholestasis of pregnancy. Her bile acids levels are 14 µmol/l are elevated. Liver function test is normal. Patient was started on Ursodeoxycholic acid. Patient was taken for emergency LSCS in view of fetal distress and delivered an alive healthy baby.
Clinical Discussion: ICP has no significant consequences for the mother but, it is associated with an increased risk of fetal distress. Complications associated with ICP include preterm delivery, IUGR, meconium-stained amniotic fluid, and fetal distress, stillbirth.
Conclusion: ICP is still now considered as ‘Puzzling disease in pregnancy’. It has significant perinatal morbidity and mortality. Although treatments has improved fetal outcome but timely identification, educating pregnant women, early diagnosis is necessary. Don’t Avoid a itch just by scratching.
Biography
Ramya V A is a Post Graduate of the Department of Obstetrics and Gynecology at Sree Mookambika Institute of Medical Science, India
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