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Chronic erythematous rash and lesions on trunk and limbs
Published in Richard Ashton, Barbara Leppard, Differential Diagnosis in Dermatology, 2021
Richard Ashton, Barbara Leppard
Prurigo of pregnancy is common, with secondary signs of scratching. It resolves at term. Check the liver function tests since itching can be due to elevated bile salts in the blood, raising the possibility of intrahepatic cholestasis of pregnancy. In this condition, itching of the palms and soles is characteristic. It can be associated with abnormal clotting (treated with vitamin K) and foetal distress. Early delivery may be necessary.
Disorders of the digestive tract
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
Intrahepatic cholestasis of pregnancy affects 0.4–1% of pregnancies in North America and western Europe, although is higher in certain groups including those from Asia (Pakistan and India), Chile, Finland and indigenous Americans22,63,64. Maternal itching (pruritus), raised serum bile acids, abnormal liver function tests and adverse fetal outcomes are the key features of ICP. It tends to develop in the third trimester but resolves quickly after delivery22,64. Box 9.10 lists features of ICP which aid diagnosis.
Investigation and management of recurrent cholestasis of pregnancy
Published in Minakshi Rohilla, Recurrent Pregnancy Loss and Adverse Natal Outcomes, 2020
Intrahepatic cholestasis of pregnancy (ICP) has long been implicated as a rare cause of antepartum stillbirths, now being categorized under the Antepartum hypoxia category (A3) for the fetus and Maternal medical condition (M4) in the World Health Organization (WHO) application of the International Classification of Diseases, 10th Revision, to deaths during the perinatal period (ICD–Perinatal Mortality, ICD-PM) classification of stillbirths [1]. Intrahepatic cholestasis of pregnancy is a pregnancy-related liver disorder [2]. It usually presents in the second and third trimesters, though cases in the first trimester have also reported [3]. It is characterized by pruritis without a rash, especially on the palms and soles, that manifests itself more at night. A rise in bile acids is noted. This entity is characterized by a resolution of the symptoms and biochemical indicators after pregnancy. Cholestasis of pregnancy is associated with adverse fetal outcome, and so it is significant in women with previously unfavorable obstetric history. A history of recurrent cholestasis with jaundice and neonatal death should also be evaluated for genetic diseases, such as progressive familial intrahepatic cholestasis (PFIC) [4]. These women are also predisposed to develop various hepatobiliary, cardiovascular, and immune-mediated diseases in later life. The defining criteria and recommendations for management and delivery timing vary in the literature.
Prevalence, risk factors and adverse perinatal outcomes for Chinese women with intrahepatic cholestasis of pregnancy: a large cross-sectional retrospective study
Published in Annals of Medicine, 2022
Kaiqi Wu, Binin Yin, Shuai Li, Xiaojun Zhu, Bo Zhu
Intrahepatic cholestasis of pregnancy (ICP), the most common pregnancy-associated liver disorder, manifests as new-onset pruritus and elevated serum bile acid, typically in the second and third trimesters of pregnancy and resolves spontaneously after delivery [1,2]. The global incidence of ICP ranges from 0.5% to 5.6%, depending on the geographic and ethnic variation, and it is highest in South America and Northern Europe [3–6]. Recently, ICP has been reported to be associated with adverse maternal and foetal outcomes, with a higher risk of preeclampsia, later hepatobiliary diseases, and gestational diabetes mellitus [7–9]. In addition, ICP may cause preterm birth, foetal asphyxia, meconium-stained amniotic fluid, cardiotocography abnormalities, a low (<7) 5-min Apgar score, respiratory distress syndrome, and even intrauterine foetal death [5,10–13]. The pathogenesis of ICP is multifactorial and remains unclear although hormonal, genetic, and environmental factors have been implicated [4,14–16]. Previous studies have shown that multiple pregnancies, in vitro fertilization (IVF), maternal age >35 years, women with a history of liver-related diseases, particularly gallstone and chronic hepatitis C infection, as well as a previous history of ICP increase the risk [8,17–21].
Recognizing skin conditions in patients with cirrhosis: a narrative review
Published in Annals of Medicine, 2022
Ying Liu, Yunyu Zhao, Xu Gao, Jiashu Liu, Fanpu Ji, Yao-Chun Hsu, Zhengxiao Li, Mindie H. Nguyen
Pruritus is a sensation that induces persistent or intermittent itching and involuntary scratching. It can affect the whole body or be confined to the limbs, especially the footplate and palm, where more intensive itchiness may occur. It is one of the most common skin abnormalities that occur in liver disease, particularly in patients with cholestatic liver disease. As a frequent concomitant symptom without visible lesions of liver cirrhosis, pruritus is usually linked to cholestasis in PBC, primary sclerosing cholangitis, obstructive gallstone disease and carcinoma of the bile duct. It can also be the most prominent symptom in certain pregnancy-associated liver conditions such as intrahepatic cholestasis of pregnancy [60]. Viral hepatitis-related cirrhosis can lead to intense pruritus, accompanied by solid crusty nodules, which are called prurigo nodularis (Figure 3(d)). Usually distributed in the extremities, especially between the knee and ankle and forearm, the lesion is associated with the topical deposition of an immune complex consisting of HBV/HCV in the skin [1]. Data from a large cohort of patients with chronic liver disease (n = 1631) suggest that the overall prevalence of pruritus was about 40% overall, higher among those with cirrhosis and as high as 50% in those with PBC and 60% in those with autoimmune overlap syndrome [61].
Effect of the increase rate of blood lipid concentration during pregnancy on the adverse pregnancy outcomes: a cohort study of 1051 singleton pregnancy
Published in Gynecological Endocrinology, 2022
Xiaoping Yu, Jinfeng Gao, Yan Huang, Yufei Zou, Ying Huang, Tao Du, Ju Zhang
The study showed that the TG concentration in pregnant women with GDM, hypertension during pregnancy, and LGA in the early and late trimesters was higher than those in non-patients, and blood lipid concentration was generally higher among pregnant women with complications during pregnancy. It suggested that blood lipid concentration during pregnancy was associated with various pregnancy complications. A previous study has reported the risk of GDM in the high TG group in the first trimester is 3.86 times that of the low TG group [14]. Other studies have also shown that TG in the first, second, and third trimesters of pregnancy is closely related to GDM and hypertension in pregnancy; TC, HDL-C, and LDL-C in the third trimester are closely related to the risk of intrahepatic cholestasis of pregnancy [5]. Unlike other adverse pregnancy outcomes, the pathogenesis of intrahepatic cholestasis of pregnancy is unclear. Moreover, there is no unified international opinion on diagnosis and treatment, and it is difficult to implement effective preventive measures. It is helpful to play an early warning role through the correlation study of other biochemical examination indexes. In addition, Wu et al. [15] demonstrated that the TG concentration in the second trimester of non-advanced pregnant women aged 20–34 are also related to the occurrence of premature babies.