產(chǎn)科學(xué)英文課件：15 ICP

1、ICP,INTRAHEPATIC CHOLESTASIS OF PREGNANCY,Intrahepatic cholestasis of pregnancy (ICP) is a reversible condition of cholestasis that happens usually in the third trimester. Findings such as pruritus, high serum bile acids levels, and abnormal liver function tests usually resolve after delivery. It is

2、 a liver disease of pregnancy associated with raised serum bile acids and increased rates of adverse fetal outcomes. Obstetric Cholestasis,What is ICP,ICP is more prevalent in Scandinavian and South American countries. Prevalence in Europe, United States, Canada and Australia is 0.1% to 1.5%. More p

3、revalent in south China, Yangtze valley(14%) ICP was associated with an increase in the risk of developing hepatobiliary diseases later in life, such as hepatitis C, cirrhosis, and gallstones,EPIDEMIOLOGY,Genetic predisposition: MDR3 (ABCB4)? ABCB11? ATP8B1? -not sure. Hormones: ICP happens late in

4、pregnancy and has a higher incidence in multiple gestation pregnancies, and that it resolves after delivery when sex hormones(estrogen) levels fall? Environment: seasonal variation、selenium Familial tendency,Pathogenesis,NOT CLEAR,Pruritus-marked dermatitis Postpartum hemorrhage Hepatic impairment,M

5、aternal risk,Intrauterine death (5% of full-term stillbirth) Fetal distress Prematurity Meconium-stained amniotic fluid RDS,Fetal risk,ICP usually commences in the third trimester although earlier start in the second trimester has been reported. The most common symptom is PRURITUS. Severity of pruri

6、tus increases at night and can involve the palms and soles. Other symptoms include steatorrhea, malabsorption of fat-soluble vitamins, and weight loss. ICP seems also to increase the incidence of gallstones and cholecystitis,Clinical presentation,Fasting serum bile acids level 10 mol/L. Aminotransfe

7、rases can be elevated as well up to 2-10 folds. Clinical jaundice is detected in 10%-15% of the cases only and bilirubin levels rarely exceed 100 mol/L. Liver biopsy can reveal bland cholestasis (intrahepatic cholestasis without parenchymal inflammation,DIAGNOSIS,MILD,Serum bile acids level 1039 mol

8、/L Bilirubin 12 mol/L Pruritus,SEVERE,Serum bile acids level 40 mol/L bilirubin mol/L Severe pruritus Other complications：PE、Twin,DEGREE,Dermatitis Acute fatty Liver of pregnancy Hepatitis HELLP syndrome,Deferential Diagnosis,The aims of management are to reduce symptoms and biochemical abnormalitie

9、s in the mother and to reduce the risk of fetal distress, preterm delivery and sudden fetal death. General: fetal monitor Drugs Obstetrical management,MANAGEMENT,Ursodeoxycholic acid (UDCA,熊去氧膽酸) : 15mg/kg/D S-adenosyl-methionine（SAM,思美泰）: 1g /D Dexamethasone: Vitamin K,DRUG,TERM: No evidence is str

10、ong enough to recommend early delivery (37wk) METHOD: Vaginal delivery: Mild 40wk C-section: Severe Abnormal history Fetal distress Other complications,OBSTETRICAL TREATMENT,Although ICP is a benign condition for the mother, poor fetal outcomes can occur. Most women have no lasting hepatic damage, but ICP recurs in the majority of cases, with variations in intensity in subsequent pregnancies. Long-term follow-up