When present, it increases the incidence of acute hepatic failure. [patient.info]

In this study only four patients (12.5%) presented with CBD stones. [saudijgastro.com]

Clinical presentation Preeclampsia, HELLP syndrome, and acute fatty liver of pregnancy share similar presentations and differentiating between the three entities can be difficult. All present late in pregnancy and can have similar clinical features. [wjgnet.com]

The presenting symptom of OC is pruritus, which is more noticeable at night. Researchers are not sure why this is. Other symptoms include dark urine, steatorrhea and, less commonly, jaundice. [rcm.org.uk]

Headaches are common, and altered sensorium may be noted on presentation as well. [glowm.com]

• Fatigue

  Some women experience fatigue, nausea or abdominal discomfort. What other problems can occur with it? This condition is potentially serious for the unborn baby with an increased risk of foetal distress, preterm labour and stillbirth. [dermcoll.edu.au]

  […] limited to that of the palms of the hands and soles of the feet, without presence of a rash Itching that is more noticeable in the evening Darker urine Less common: Lighter stools Increased clotting time (due to possibly associated vitamin K deficiency) Fatigue [en.wikipedia.org]

  Clinical features • Nonspecific symptoms like – Nausea and vomiting, – Malaise and fatigue, – Jaundice, – Thirst, headache, and – Altered mental status. – Pruritus (overlap with ICP ) • There can be signs and symptoms of acute hepatic failure. 22. • The [slideshare.net]

  Ninety percent of patients experienced fatigue or malaise preceding their seeking medical attention. Half to two thirds report epigastric or right upper quadrant pain. [glowm.com]

• Asymptomatic

  Acute pancreatitis in pregnancy is usually biliary in origin (70-90%) and may be the first presentation of asymptomatic gallstones in 1.2-11% of cases [13], [14]. [saudijgastro.com]

  Of interest, a subgroup of asymptomatic healthy pregnant women with total serum bile acids above the upper normal limit of 11 μ M in late gestation and normal serum liver tests has recently been defined as asymptomatic hypercholanemia of pregnancy (AHP [ojrd.biomedcentral.com]

  Supportive Benign HBV High if mother is HBeAg + and during third trimester Viral syndrome or asymptomatic Supportive Benign HCV 3.8% Often asymptomatic Supportive Benign CMV Up to 30%-40% Mononucleosis-like Supportive High morbidity to child CMV, cytomegalovirus [clevelandclinicmeded.com]

  Many studies have revealed that 60-90 % pregnant women having gallstones were asymptomatic and it diagnosed in routine perinatal check-up.[1] Pregnancy is one of contributing factor for the formation of cholesterol gall stone which is reported in 3.3 [article.sapub.org]

  Liver biopsy shows periportal fibrin deposits. 108 Even in asymptomatic cases, perisinusoidal deposits of fibrinogen may be observed. [glowm.com]

• Anorexia

  Anorexia, nausea, and vomiting also may be reported by some patients. [glowm.com]

  • Abdominal pain, biliary colic, fever, anorexia, nausea, vomiting, and arthralgias are absent. 10. [slideshare.net]

  Although rare (with an incidence of one in 13,000), acute fatty liver of pregnancy is a life-threatening condition, with an 18 percent maternal and a 23 percent fetal mortality rate. 30 Symptoms associated with acute fatty liver of pregnancy include anorexia [aafp.org]

• Liver Disorder in Pregnancy

  It occurs in 3% to 10% of all pregnancies. Several disorders contribute to liver disease in pregnancy ( Box 1 ). [clevelandclinicmeded.com]

• Aspiration

  […] if untreated [ edit ] Maternal consequences include the following: Itching, which can become intense and debilitating Premature labor Deranged clotting, which requires Vitamin K Fetal consequences include: Fetal distress Meconium ingestion Meconium aspiration [en.wikipedia.org]

  (intrapartum fetal distress, meconium aspiration, and neonatal respiratory distress) • These complications correlate with maternal bile acid levels > 40 μmol/L. • More likely if the disorder begins earlier in pregnancy. 12. [slideshare.net]

• Nausea

  Some women experience fatigue, nausea or abdominal discomfort. What other problems can occur with it? This condition is potentially serious for the unborn baby with an increased risk of foetal distress, preterm labour and stillbirth. [dermcoll.edu.au]

  However, when a person has obstetric cholestasis there may be other more serious symptoms like: intense itching especially bad at night on the arms, legs, palms and soles tiredness difficulty sleeping loss of appetite nausea even at later stages of pregnancy [news-medical.net]

  It seems that the severity of nausea and vomiting correlates well with the degree of liver enzymes elevation[ 4 ]. No specific abdominal ultrasound findings are associated with HG. [wjgnet.com]

  The presenting clinical features of liver disease in pregnancy are often nonspecific and consist of jaundice, nausea, vomiting and abdominal pain. [patient.info]

• Loss of Appetite

  However, when a person has obstetric cholestasis there may be other more serious symptoms like: intense itching especially bad at night on the arms, legs, palms and soles tiredness difficulty sleeping loss of appetite nausea even at later stages of pregnancy [news-medical.net]

• Jaundice

  JAUNDICE DURING PREGNANCY ... - - 17 1) Incidence of jaundice durip. g pregnancy 17 2) Classification of jaundice during pregnancy 17 3) Frequency distribution of different diseases causing jaundice during pregnancy ... ... '. 20 4) Review of literature [books.google.de]

  because of jaundice of 2 weeks'. .. [nejm.org]

  Intrahepatic cholestasis of pregnancy Also known as recurrent cholestasis of pregnancy, obstetric cholestasis, cholestasis of pregnancy, recurrent jaundice of pregnancy, cholestatic jaundice of pregnancy, idiopathic jaundice of pregnancy, prurigo gravidarum [dermcoll.edu.au]

  Jaundice is a common and usually harmless condition in newborn babies that causes yellowing of the skin and the whites of the eyes. The medical term for jaundice in babies is neonatal jaundice. [nhs.uk]

  In its severe form, malaria causes jaundice. There are many possible causes that lead to jaundice after a person has been infected with malaria. Read on for the details. [onlymyhealth.com]

• Recurrent Jaundice

  ALTHOUGH there have been numerous reports in the European literature on a syndrome of recurrent jaundice in late pregnancy we have found only sparse reference to it in the American literature. [nejm.org]

  Synonym(s): cholestasis of pregnancy, recurrent jaundice of pregnancy. intrahepatic cholestasis of pregnancy Abbreviation: ICP A complication of approx. 1% of pregnancies in which elevated levels of pregnancy hormones cause obstruction to bile flow within [medical-dictionary.thefreedictionary.com]

  Intrahepatic cholestasis of pregnancy Also known as recurrent cholestasis of pregnancy, obstetric cholestasis, cholestasis of pregnancy, recurrent jaundice of pregnancy, cholestatic jaundice of pregnancy, idiopathic jaundice of pregnancy, prurigo gravidarum [dermcoll.edu.au]

  Recurrent jaundice caused by recurrent hyperemesis gravidarum. Abstract The existence of jaundice induced by hyperemesis gravidarum is controversial. [gut.bmj.com]

• Liver Dysfunction

  Although elevated aminotransferases is expected, the severity of liver dysfunction is not always reflected by the degree of elevation. Alkaline phosphatase is usually elevated. [wjgnet.com]

  Pregnancies complicated by liver disease and liver dysfunction. Obstet Gynecol Clin North Am. 1992;19:745–63. 4. Smoleniec JS, James DK. Gastrointestinal crises during pregnancy. Dig Dis. 1993;11:313–24. 5. Sjogren MH. [aafp.org]

• Pruritus

  These are deposited within the skin, causing intense pruritus. [flipper.diff.org]

  […] on pruritus as compared to UDCA monotherapy [ 42 ]. [ojrd.biomedcentral.com]

  […] intrahepatic cholestasis of pregnancy intrahepatic cholestasis with centrilobular bile staining without inflammatory cells or proliferation of mesenchymal cells; clinically characterized by pruritus and icterus; of unknown cause but associated with high [medical-dictionary.thefreedictionary.com]

  Pruritus (itching) is a common symptom of pregnancy, affecting around 20% of women. [3] The majority of times, itching is a minor annoyance caused by changes to the skin, especially that of the abdomen. [en.wikipedia.org]

  Kenyon AP, et al. (2001) Pruritus may precede abnormal liver function tests in pregnant women with obstetric cholestasis: a longitudinal analysis. BJOG 108 : 1190-2. [rcm.org.uk]

• Erythema

  THE LIVER IN NORMAL PREGNANCY 9 Liver palpation. ... 9 Spider angiomas and palmar erythema 9 Histological changes in liver biopsies 10 Liver blood flow ... 10 Hemoglobin and serum iron ... 11 Total leucocyte and differential count. 11 Prothrombin time [books.google.de]

  The physical examination of a pregnant woman can show skin changes suggesting chronic liver disease, such as palmar erythema and spider angiomas. [clevelandclinicmeded.com]

• Skin Rash

  There are no skin rashes. Jaundice affects 20% of patients and typically is mild. 63 Abdominal pain is unusual, and most patients appear clinically well; however, nocturnal pruritus and insomnia may cause increasing distress to the expectant mother. [glowm.com]

  Pregnant women with hepatitis E infection exhibit markedly increased fatality rates (10 to 20 percent). 6, 8, 9 Disseminated HSV infection is associated with prodromal systemic illness, vesicular skin rash and leukopenia. 10, 11 Maternal and fetal mortality [aafp.org]

• Excoriation

  There is no rash but the skin may show scratch marks (excoriations) or become yellow (jaundiced). This condition typically develops late in pregnancy and resolves within days after the baby is born. [dermcoll.edu.au]

• Irritability

  The excess bilirubin in blood is carried around to various organs and tissues and leads to deposition and irritation under the skin causing itching. Excess bile in the mother’s blood may also put the baby at risk. [news-medical.net]

  Mothers who consume alcohol during pregnancy can have premature babies, stillbirths, babies with neonatal alcohol withdrawal (characterized by jitteriness, irritability, and poor feeding in the first 12 hours of life), and infants with fetal alcohol syndrome [clevelandclinicmeded.com]

• Dark Urine

  The following signs and symptoms may be present in cases of cholestasis of pregnancy: intense itching, especially on the palms of the hands and soles of the feet dark urine light-colored feces jaundice, giving the whites of the eyes, skin and tongue a [medicalnewstoday.com]

  Other symptoms include dark urine, steatorrhea and, less commonly, jaundice. Itching can be intense or mild and there appears to be no correlation between intensity of itch with increased fetal risk. [rcm.org.uk]

  Other signs such as pale stools or dark urine may indicate a problem with your liver, including OC/ICP. Your doctor can diagnose OC/ICP from blood tests called liver function tests (LFTs) and a serum bile salt test. [britishlivertrust.org.uk]

The underlying disorder can have a significant effect on morbidity and mortality in both mother and fetus, and a diagnostic workup should be initiated promptly. [clevelandclinicmeded.com]

What is the treatment for ICP? Despite the possible outcomes of ICP, proper treatment provides a great degree of reduction in both fetal risk and maternal symptoms. [liverfoundation.org]

Treatment Treatment may not be necessary if cholestasis is mild and occurs late in pregnancy. Treatment normally aims to relieve symptoms, mainly the itching, and to prevent potential complications. [medicalnewstoday.com]

While jaundice isn't usually a cause for concern, it's important to determine whether your baby needs treatment. [nhs.uk]

Thus, early recognition, treatment, and timely delivery are imperative. [emedicine.medscape.com]

Twenty-two patients (69%) completely recovered on conservative treatment. All had LC after delivery with satisfactory outcome. The remaining ten patients (31%) needed further treatment for failure to respond to initial therapy or recurrent symptoms. [saudijgastro.com]

Jaundice in pregnancy carries a grave prognosis for both the fetus and the mother, and is responsible for 10% of maternal deaths. The present study analyzes the causes and the fetomaternal outcome in pregnancies affected with jaundice. [ijrcog.org]

Prognosis Hyperemesis gravidarum is usually a reversible condition with no permanent damage to the liver and almost never fatal. [wjgnet.com]

Maternal prognosis is good and symptoms resolve rapidly after delivery,accompanied by normalization of serum liver test. ICP recurs during subsequent pregnancies in 45-70% with varying severity of recurrent episodes. [flipper.diff.org]

There is generally a favourable prognosis for both mother and baby. Pre-eclamptic liver disease and HELLP See the separate HELLP Syndrome article for further details. [patient.info]

Pregnancies complicated by HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): subsequent pregnancy outcome and long-term prognosis. Am J Obstet Gynecol. 1995;172(1 Pt 1):125–9. 25. [aafp.org]

The etiology of this syndrome is unknown, but the clinical and laboratory findings are sufficiently distinctive to separate it from other causes of jaundice. [nejm.org]

The cause of ICP is unknown but is thought to be multifactorial with genetic,hormonal and environmental involvement.Family clustering and varying incidence in different geographic regions speaks strongly for a genetic etiology of ICP. [flipper.diff.org]

Etiology and pathogenesis The etiology of ICP is not completely understood and is still under discussion. Genetic and hormonal factors, but also environmental factors may contribute to the pathogenesis of ICP [ 1 ]. [ojrd.biomedcentral.com]

ICP has no clear etiology, and it is believed to be a multifactorial disorder with environmental, hormonal, and genetic contributions. [emedicine.medscape.com]

Etiology of cirrhosis in pregnancy is similar to that in the nonpregnant state and commonly includes alcohol and viral hepatitis C and B. Cirrhosis can affect ovulation and cause infertility. [clevelandclinicmeded.com]

Acute fatty liver of pregnancy Epidemiology It is a rare condition with an incidence of 5 in 100,000 pregnancies. [ 8 ] Acute fatty liver of pregnancy (AFLP) tends to occur in late pregnancy. [ 3 ] Risk factors include first pregnancies, pre-eclampsia [patient.info]

EPIDEMIOLOGY The incidence of ICP varies widely with geographical location and ethnicity. 1 to 2 pregnancies in 1000 are affected by cholestasis. it is most common in South America, particularly in Chile, where the early reports described an overall incidence [flipper.diff.org]

[…] findings remains to be fully elucidated. [17, 18] A study by Abu-Hayyeh et al found that sulfated progesterone metabolites are a prognostic indicator for ICP and can help predict onset of ICP and distinguish it from benign pruritus gravidarum. [19] Epidemiology [emedicine.medscape.com]

Epidemiology ICP has been observed in almost all ethnic groups, but there is relevant geographical variation in the incidence of ICP [ 1, 4 ]. [ojrd.biomedcentral.com]

It typically arises in the third trimester of pregnancy, although it has been reported as early as 13 weeks' gestation. 18 – 20 The pathophysiology of intrahepatic cholestasis of pregnancy remains poorly understood. 19 Pruritus alone occurs in 80 percent [aafp.org]

[…] microvesicular steatosis cannot be detected as well as the more common macrovesicular fatty change, in which imaging is very sensitive. 123 Although the exact mechanism of liver injury still is unknown, great advances have been made in understanding the pathophysiology [glowm.com]

Pathophysiology Affected individuals have a defect involving the excretion of bile salts, which leads to increased serum bile acids. [emedicine.medscape.com]

There are no clinical markers that predict the course of a pregnancy and the pathophysiologic mechanisms are not always understood, but knowledge and management of the preconception liver disease and efficacious pre-pregnancy and prenatal care are essential [clevelandclinicmeded.com]

Treatment normally aims to relieve symptoms, mainly the itching, and to prevent potential complications. [medicalnewstoday.com]

The gallbladder or its bile ducts can become blocked, preventing excretion of bilirubin into the intestine. Bilirubin will then back up into the liver and then into the bloodstream. [medbroadcast.com]

Many of these women are sexually active and do not take effective measures to prevent pregnancy. [clevelandclinicmeded.com]

There’s no real way to prevent newborn jaundice. During pregnancy, you can have your blood type tested. [healthline.com]

 Infusion of concentrated glucose solution may be required to treat or prevent hypoglycemia. 26.  Prompt delivery  The route should be guided by obstetric indications. [slideshare.net]