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Abstract
The incidence of intrahepatic cholestasis (ICP) in pregnancy, a liver condition, is increasing, suggesting a greater awareness of the disease. While this condition is an annoyance for a mother, typically causing intense itchiness of the hands and soles of the feet, she will return to normal after delivery. However, this condition has the potential to cause premature delivery, fetal distress and fetal death, so appropriate management is very important. Currently, guidelines available in North America conflict with guidelines in the United Kingdom. The purpose of this research is to establish evidence-based, current practice guidelines for managing cholestasis in pregnancy within a local context. A modified Delphi technique will be utilized with the goal of achieving consensus among local obstetricians about the management of ICP. It is anticipated that two rounds of questionnaires will be disseminated to the group. The content of the questionnaires and the resulting guideline, will take into consideration the unique health care environment and resources in one northeastern Ontario community.
Highlights
La fréquence de cholestase intrahépatique pendant la grossesse, une affection hépatique, augmente, ce qui suggère une plus grande prise de conscience de la maladie
In circumstances where a variety of health care providers are involved in the management of a condition, it is optimal that all providers are aware of the best evidence and approach to be taken within their circles of care
The incidence of ICP ranges from 1 case in 1000 to 1 in 10,000 deliveries throughout North America, Asia and Australia (Reyes, 2008)
Summary
La fréquence de cholestase intrahépatique pendant la grossesse, une affection hépatique, augmente, ce qui suggère une plus grande prise de conscience de la maladie. For conditions where there are no clinical guidelines and scant evidence to support practice decisions, it is essential that there is a common understanding among local care providers when considering diagnosis, treatment and overall management of disease processes. The need for a comprehensive algorithm based on the best available peer reviewed evidence supported by all practitioners is important in the optimal care of pregnant women and their unborn babies. This project arose from an observation that in the target community in previous years there were no reports of ICP, but in the in the latter part of 2015 to mid 2016 where there was more than 10 cases of ICP. The increased incidence along with the inconsistent management was the impetus for working toward a consensus in the approach to the management of this condition
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