Intrahepatic Cholestasis of Pregnancy , RCOG Guideline (2022)
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- Опубліковано 25 жов 2022
- This video is about latest GTG , 2022 , Intrahepatic Cholestasis of Pregnancy . It not only explains the similarities and differences between the previous version and the current guideline but also highlights the key points and recommendations in the latest guideline . The classification of Intrahepatic Cholestasis is new in this guideline and based upon the current classification the timings of delivery has been revised in this guideline. For previous version of this guideline , just follow this link ;
• Obstetric Cholestasis,...
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Ma'am u really make a very wonderful summary of guidelines
Thanks alot dear .
Thank you
nice and wel done
Excellent mam make videos every topic from guildlines we wil wait
Thanks alot Geeta. I am trying my best to keep the channel standard upto expectation. Thanks alot for appreciation and on every Monday and Thursday , I will come up with new guidelines video and multiple other topics as well.
Excellent😍
Thanks.
☺☺☺☺
Welldone
Thanks for appreciation.
Good
Thank yo so much .
My Sister in law has bile acid level of 243. What are chances of normal delivery?? She has Jaundice of level 8 and haemoglobin of 7.5 level.
Ma'am my sgpt is 39 and sgot is 43 and alp is 399...I am in 37th week...pls help me what should I do?
We need video about management vault prolapse
Vault Prolapse management is best explained in RCOG guideline about managment of Post hystrectomy Vault Prolpase.
ua-cam.com/video/825IuNtN914/v-deo.html
ua-cam.com/video/MBOowcfCr44/v-deo.html
For POP-Q , watch this video
ua-cam.com/video/dTq7cJgsRks/v-deo.html
My ALT (SGPT) is 69 U/L and AST is 70 plz guide me is it mild or moderate??? Brief me about complications
In the latest rcog guideline about Obs Cholestasis , the division into Mild , Moderate and Severe types is done on the basis of Bile acids level.
Bile acid=19-39micromol/L (mild ICP)
Bile acids 40-99 micro mol /L (moderate ICP)
Bile acids 100 micro mol /L or more (severe ICP)
So my suggestion to you is to do Bile acid level which is more sensitive and specific as compared to ALT.
In your case 69 U/L ALT level is signficant , as the level about 30 in pregnancy is significant.
Possible complications of Obstetric Cholestasis (especially if left untreated) include meconium stained liour , intrauterine death , stillbirth and even if baby is born he/she may suffer from Acute respiratory distress syndrome or increased NICU admissions.
Im currently 31 week serum bile acid levels 111, taking urso since 5 days,
Dr suggested for delivery by 35th week.
What should i do to reduce bile acid, is it possible that it can reduce bh taking medication,
This level is non fasting or fasting
Latest guidelines of 2021 and 2022
Mam my total bilirubin 0.6 serum gamma gt 30 ALT 364 ALK 117 and AST 254 and I'm GDM 33 weeks pregnant what should I do..my ALT and ast not cure after taking ursodioxicolic acid
Same for me , doctor suggested nusam 400 with udiliv 450
@@cherry2423frk pda apko
I wanted to ask if normal delivery is possibile in this condition?
Yes it is as long as your levels stay within a safe range. I had 2 normal deliveries and had to be induced with the last one.
I'm suffering from this problem. My total serum bile acid level is 12.4umol/l. ALT is 103, AST 58 and Alk.phosphate is 248. Kindly guide me when i should go for delivery. As my doctor is not telling me anything satisfactory. Thank you
Although your ALT is raised but as your Bile acids level is normal as per new guideline.
When the bile acid level is below 19 micr mol/L , the risk of stillbirth is similar to the background risk , means the pregnancy can be taken upto 40 weeks if no other risk factor exists.
But as your ALT is raised you need to keep an eye on fetal movements and repeat ALT at twice weekly intervals.
Also mention your gestational age here so that I can give you better idea about your antenatal plan.
It's 37 weeks my ALT is 53 and bile acid level are 11. Kindly guide
I just got symptoms at 39 weeks, can I go to 41 weeks?
Even in the mild case of Obstetric Cholestasis , pregnancy should be terminated at 40 weeks not beyond that.
Now whether your pregnancy is the category of mild , moderate or severe , your bile acids level will decide that.
So tell me your ALT nad Bile acid level .
Is it dangerous to have c section delivery in this condition when previously you have 2 scissors, patient can be cure? Or is it dangerous? My wife is facing this condition in 34th week but unfortunately our gynecologist is not giving us satisfactory answer
In setups like ours in Pakistan , its quite risky to give trial of labour to a patient with 2 previous cesarean sections. In UK , USA and other developed countries where one to one support is provided by the midwife and each doctor to every single patient , the trial of labour is given to patient with previous 2 cerean section.
But in out hospitals , the increased patient 't number , the lack of fascility , the lack of staff and further facscilities its is alomost impossible to give trial of labour to previous 2 scars.
However if a patient come with advanced labour with good progress and by clinical examination we get an idea that yes this patient can be delivered easily then we give trial of labour to them as well.
@@AAUN thank you for your brief answer, we want to have scissor as well coz it's safe, I was just worried that if there is a risk in scissor or not
@@aowaiskhan you are welcome and if there is any Gynae and Obs health related problem , you can ask in this comments section.
@@AAUN thank you
If the patient have gestational diabetes with ICP than What is the best time for delivery ?
My bile acid was 75.5 around 34 weeks but with medicine it is now came to 17 and i am currently in 36 weeks.i have gestational diabetes.
When the bile acid level lies in the range of 40-99 micmol/L , then according to RCOG , it is categorisd as Moderate Intrahepatic Cholestasis.
In that case delivery is recomemended at 38 weeks.
But now as it has come to 17 means its Mild Intrahepatic Cholestasis , so delivery is planned at 40 weeks.
As far as Gestational Dibetes is concerned , if the sugar level is well controlled then delivery can be delayed upto 40 weeks. In case of Type 1 or type 2 Diabetes or uncontrolled Diabetes Mellitus the delivery is planned at 38 weeks.
But in your case due to Mild Obstetric Cholestasis and lets suppose your sugar level is under control so the delivery should be planned at 40 weeks of gestation , whether by Induction of Labour or by Cesarean Section , that depends upon other obstetric inducations.
What medications you took?
Hi @Survi ,hope you and baby are doing fine. I am in 30w preg with ICP and GDM similar to yours. Wanted to check how did you manage and when was the delivery done, what steps to be taken. Let me know if we can connect once😊
@@pubalibhaduri5522 since when are you suffering from ICP? When did it start?
@@theBIproject Around 3 weeks back. Bile level were 193 on 12th May and on 26th it came as 99 after having Urso for 2 weeks.
Please help my bile acid level is 24.5 but my dr suggested for delivery after 37 week even my 37 week is running please mam help
If peak bile acid is 19-39 micro mol/L. then delivery can be planned till 40 weeks. So don't worry about this level of bile acid but keep an eye on fetal movments if u noticed decrease in movments then consult your obstetrician.
@@AAUN thank you mam but my alkaline phosphate is 428 and sgot and sgot is under 120 so alt could be the reason for early term delivery
@@poojasingh-lb2gw
SGOT is same as ALP , the valve of which is not significant in pregnancy as it is released from placenta.
However ALT or SGPT indicate hepatocyte damage whereas Obs Cholestasis measn bile acid stasis in the canaliculi.
So for Obs cholestasis we take bile acid as reliable marker.
For raised ALT we need to find other causes of hepatocytes damage for which your detailed history , examination and essential investigations are needed to be done.
I would advice you to consult Physician for that purpose.
@@AAUN mam now my itching is 80 percent controlled after a week...my physician is suggesting delivery after 37 week...by induing labour would like to know is it safe or normal delivery is possible in running 38 week
@@AAUNhi mam can you help me to read my report .i recently get this test done but doctors not able to describe it properly
AST 156
ALT 217
LDH 338
Bilirubine total 5.5
Can you please guide,it would be great help
Ma'am hepatitis C in pregnancy
ok dear no problem . Inshallah very soon I will make presentation on Hepatitis C in Pregnancy and will notify you as well here.
For Hepatitsi Serology you can watch this video
ua-cam.com/video/FA7OYLUj7qs/v-deo.html
Next presntation will be on Malaria in Pregnancy.
After that someone else has asked me present Male Infertlity. Next to that will be Hepatitis C inshallah.
@@AAUN thank you so much madam
Dr. Saima Shoaib , I have made presentation on Hepatitis C in Pregnancy . You can watch it by following this link :-
ua-cam.com/video/bFAM9eMxBf8/v-deo.html
@@AAUN thank u so much ma'am
ApLS
Ok dear.
Inshallah I will make presentation on APLS as well and will notify you once I upload it.
On your request I have made video on APLS . Click this link
ua-cam.com/video/PLJffcXsdkI/v-deo.html