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meaning intrahepatic cholestasis ( ICP ) is the most common gestation - specific liver disease . Symptoms include pruritus throughout the body , including the palms and soles , and elevated gall acid stratum , but may not be company by changes in liver function exam ( LFT ) results . The aetiology of cholestasis of pregnancy is regulate by a combining of genetic , internal secretion , and environmental element . Risk factors include multiple gestation , in vitro fertilization , ripe childbirth , pregnancy story , family story , and hepatitis C infection.(1 )
How To Diagnose Cholestasis Of Pregnancy?
Determination Of Serum Bile Acid Concentration : It is the most valuable method acting for diagnosing acholia of pregnancy and the glycolic specific grounds of cholestasis of maternity . The bile superman in the bile is mainly glycolic acid ( CG ) and taurine with a ratio of 3 : 1 . The determination of the serum glycolic acid in pregnant women is the most sensitive method acting for the early diagnosing of acholia of gestation .
Liver Function Measurement : Aspartate aminotransferase ( AST ) and alanine aminopherase ( ALT ) are mild to moderately elevated in most cholestasis of gestation patients ( 2 to 10 times the normal level ) . ALT is more sore than AST ; some patient have lower serum bilirubin or moderately elevated .
Pathological Examination : Postpartum pathologic examination show up that the placenta and amnic tissue layer showed dissimilar degrees of yellow and grey memorial tablet , chorionic home plate and amnic membrane deposited gall salt , trophoblasts swell and increased in number , chorionic matrix edema , and minute space ; liver tissue biopsy of cholestasis of pregnancy patients shew liver cells .
There was no glycolic inflammation or degeneration . Only the hematoidin in the fundamental region of the hepatic lobules was mild , and acholia of the gall epithelial duct and bile thrombosis were usually maintain . Electron microscopy can unwrap dilate hairlike bile ducts with microvilli edema or disappeared .
Differential Diagnosis : The diagnosis for acholia of pregnancy should keep out other diseases that can causeitching , thorniness , and abnormalliver function . If patients with hard vomiting , psychiatrical symptom or high blood press , your doctor may study pregnancy , acute fatty liver , and preeclampsia ; modest aminopherase story , passably advance should consider pregnancy with hepatitis , especially meaning fusion chronic hepatitis.(3 ) ( 4 )
What Is The Best Medicine For Cholestasis Of Pregnancy?
Treatment calculate to salvage pruritus symptom , restore liver function , low blood acid levels , with stress on foetal monitoring intrauterine condition , to detect fetal hypoxia and take appropriate military action .
Proper bottom sleep , take the left side - consist place to increase the placental blood flow , give intermittent atomic number 8 inhalation , hypertonic glucose , vitamin , and energy mixture , both to protect the liver and improve the fetus ’s leeway to hypoxia . Checking the liver function , origin bile superman level , and bilirubin regularly is essential .
The medical specialty that can reduce the clinical symptoms of pregnant women , the biochemical indicators of cholestasis and the betterment of the perinatal prognosis are :
Adenosylmethionine is the drug of choice for cholestasis of pregnancy . The drug can keep acholia have by elevated oestrogen and protect the liver of oestrogen - sore mothers . Clinically , it can meliorate the symptoms of cholestasis of gestation and delay the further exploitation of the disease .
Ursodeoxycholic Acid prohibition after parenteral governance of hydrophobic bile acid further reabsorption of gall Zen to reduce , better the foetal environment , thus extend the gestational age . Pruritus symptom and biochemical index can be improved significantly .
Decadron inducible activity through the placenta to reduce the fetal secernment of adrenal DHEA reduced estrogen product , reduce cholestasis ; further foetal lung due date , to avoid untimely respiratory distress syndrome of the infant ; reduce pruritus symptom .
Phenobarbital drug inducible cytokine activity and P450 generated , thereby increasing bile flow , amend pruritus symptoms.(5 )
The Common Cause Of Cholestasis During Pregnancy
acholia in pregnant women is provoked due to an gain in the output of oestrogen . This increases the production of gall acids that make itching when it comes to the tegument . In most cause , this disease does not posture a risk to the development of the endocrine foetus . misdemeanour of liver role , expansion of the urinary tract organ and gallbladder and accordingly , put pressure on these organ by the uterus . itch is often a symptom that indicates a malfunction in the piece of work of these organs . In extreme cases , next mother may be ask to be hospitalized.(2 ) ( 3 )
Genetic And Environmental Factors : epidemiologic studies find that the incidence of acholia of gestation is related to the season , the incidence is higher in winter than in summer , and it is significantly higher in women with a chronicle of cholestasis of maternity in their mob ( mothers or sisters ) , betoken that transmissible and environmental factors wreak a role in the cholestasis of pregnancy materialization .
drug : Some drug that reduce bile duct exile , such as Imuran take after kidney transplantation , can induce acholia of pregnancy.(2 ) ( 3 )
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