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What is intrahepatic cholestasis? www.rcog.org.uk [Accessed March 2015] RCOG. Clinical Knowledge Summaries - CKS (Add filter) 01 April 2020 The main cause of itch without an associated rash in pregnancy is obstetric cholestasis. Jaundice is most easily recognised in fair-skinned individuals and difficult to detect in darkly pigmented patients. BMJ 348:g3489 Exclude obstetric cholestasis by checking LFTs (raised AST/ALT; alkaline phosphatase is increased in normal pregnancy and so an unreliable marker of cholestasis in pregnancy). Summary. However, it should be considered because scratching may cause skin irritation and excoriation that may resemble a rash. Obstetric cholestasis is more common in women from certain ethnic groups, particularly those from South American and Scandinavian regions. Obstetric cholestasis. Treatment of cholestatic pruritus. cks.nice.org.uk [Accessed April 2015] RCOG 2011. Itching usually occurs on the hands and feet but can also affect other parts of the body. www.rcog.org.uk [Accessed March 2015] RCOG. Intrahepatic cholestasis of pregnancy (ICP), also known as obstetric cholestasis (OC), is a liver disorder that can develop during pregnancy. The clinical importance of obstetric cholestasis lies in the potential fetal risks, which may include spontaneous preterm birth, iatrogenic once obstetric cholestasis is diagnosed, it is reasonable to measure LFTs weekly until delivery(6) Management: seek specialist advice; More detailed information about Intrahepatic cholestasis of pregnancy (ICP) is described in the linked item. 38 The fetal risks include premature delivery, meconium aspiration and possibly fetal demise. What causes obstetric cholestasis? In Australia OC affects less than one in 100 mums-to-be (SAH 2016). The cause of obstetric cholestasis is not yet understood, but it is thought that hormones and genetic and environmental factors (for example diet) may be involved. See the section on in the CKS topic on for further information. What is obstetric cholestasis? National Institute for Health and Care Excellence, Clinical Knowledge Summaries. 2015. If you have obstetric cholestasis during one pregnancy, there is a high risk that it may happen again in a future pregnancy. When bile flow is stopped, the pigment bilirubin (a waste product formed when old or damaged red blood cells are broken down) escapes into the bloodstream and accumulates. Obstetric cholestasis (also known as intrahepatic cholestasis of pregnancy) is an uncommon but serious liver disorder that can develop during pregnancy. For more information, see the CKS topic on Itch - widespread. Obstetric cholestasis is a multifactorial condition that is characterised by abnormal liver function tests, jaundice and intense pruritis (typically affecting the palms and soles of the feet). Infection is worldwide and usually asymptomatic. The cause of impaired bile flow in obstetric cholestasis is currently unclear but is thought to involve a combination of hormonal, genetic, and environmental factors. Obstetric Cholestasis (OC) is a multifactorial condition of pregnancy characterised by intense pruritus in the absence of a skin rash, with abnormal liver function tests (LFTs), which resolves following birth. OC is also called cholestasis of pregnancy, or intrahepatic cholestasis of pregnancy (ICP). Make a working diagnosis of obstetric cholestasis if a woman reports... More: Guidance. Royal College of Obstetricians and Gynaecologists. Aim/Purpose of this Guideline 1.1 To give guidance to obstetricians and midwives on the management of women with Obstetric Cholestasis (OC). 1.2 This version supersedes any previous versions of this document. Obstetric cholestasis is a cause of mild jaundice. Intrahepatic cholestasis of pregnancy (ICP), also known as obstetric cholestasis, cholestasis of pregnancy, jaundice of pregnancy, and prurigo gravidarum, is a medical condition in which cholestasis occurs during pregnancy.It typically presents with itching and can lead to complications for both mother and baby.. Pruritus (itching) is a common symptom of pregnancy, affecting around 23% of women. The condition is normally recognised when the mother complains of itching, and is usually diagnosed in the third trimester. The condition causes bile acids and other harmful substances to build up in the liver, which can then “leak” into the bloodstream (6, 7). You may also hear IPC called obstetric cholestasis of pregnancy (OC). The main cause of itch without an associated rash in pregnancy is obstetric cholestasis. Royal College of Obstetricians and Gynaecologists, Green-top guideline, 43. 28 ICP has a high recurrence rate – as high as 70% – in subsequent pregnancies. The condition triggers intense itching, but without a rash. It is most easily seen in the sclera and best seen in natural light by pulling down the lower eyelid to expose the sclera and asking the patient to look up. Basis for recommendation The recommendations on how to manage women with obstetric cholestasis are based on expert opinion in the Royal College of Obstetricians and Gynaecologists guideline Obstetric cholestasis , … ... Obstetric Cholestasis (OC) affects 0.7% of pregnancies in the UK. London: RCOG press. Obstetric cholestasis (also known as intrahepatic cholestasis of pregnancy/ICP) is the most common cause of itch that presents without a rash in pregnancy. Current information and guidance ... 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