علاج ركود صفراوي الحمل مع حكة في جلد طبيعي المظهر وذروة الأحماض الصفراوية ≥100 µmol/L (ركود صفراوي داخل الكبد الشديد)

References

DOI: 10.1111/1471-0528.17206

• The diagnosis of ICP should be considered in pregnant women who have itching in skin of normal appearance and raised peak random total bile acid concentration of 19 micromol/L or more.
• Severe ICP: itching and raised peak bile acid concentrations ≥100 micromol/L.
• Consider topical emollients such as aqueous cream (with or without menthol added) to ameliorate skin symptoms.
• Consider antihistamine agents, such as chlorphenamine, particularly at night although the effectiveness of this treatment is uncertain in women with ICP.
• Other common antihistamine agents including loratadine and cetirizine are also used in pregnancy for other indications but do not have sedative side-effects.
• If women have symptoms such as steatorrhoea, coagulation assessment should be performed and use of vitamin K treatment considered (prescribed as a water-soluble formulation such as menadiol sodium phosphate at a dose of 10 mg daily).
• Consider planned birth at 35–36 weeks' gestation in women with severe ICP with peak bile acids 100 micromol/L or more; advise them that the risk of stillbirth is higher than the background risk.
• If planned early birth is indicated, induction of labour should be considered unless other reasons for caesarean birth are present.