Abstract
A 26-year-old gravida 3 para 1+1 was referred for antenatal care. In her last pregnancy she had a early spontaneous preterm delivery at 32 weeks and 2 days complicated by intra hepatic cholestasis of pregnancy. She had a strong family history of ischemic heart and combined hyperlipidaemia. In view of her past obstetric history a baseline liver function test and fasting bile acid assay was carried out. Upto 21 week her Bile acids were normal but at 22 weeks her fasting bile acid assay increased to the upper limit of normal (9 µmol/L).Ursodeoxycholic acid was started from 28 weeks gestation on a dosage of 500 mg b.i.d., which was subsequently increased to 500 mg t.d.s. at 32 weeks.At 34 weeks she gave a history of occasional right upper quadrant abdominal pain and her biochemistry revealed raised serum aspartate transaminase ,alanine transaminase, fasting serum triglyceride and cholesterol levels 58 IU,79 IU/L,18.37 mmol/L and 25.7 mmol/L respectively. The triglyceride level was too high to calculate the low density lipoprotein cholesterol. A diagnosis of severe intrahepatic cholestasis of pregnancy in a patient with background familial combined hyperlipidaemia was made. Ultrasound abdomen and cardiotocography was normal. She had normal delivery. In cases of early onset cholestasis of pregnancy we suggest that lipid profiles are checked in these patients to rule out hyperlipidaemia and its attendant short term and long-term risks. More research will be required to ascertain if there is a link between these 2 disorders.
Highlights
In cases of early onset cholestasis of pregnancy we suggest that lipid profiles are checked in these patients to rule out hyperlipidaemia and its attendant short term and long-term risks
We report a case of severe early onset reoccurring intrahepatic cholestasis of pregnancy (ICP) in a patient with exacerbation of familial combined hyperlipidaemia (Fredrickson/WHO type V)
At 22 weeks her fasting bile acid assay (BA) assay increased to the upper limit of normal (9 μmol/L), her liver function test (LFT) remained normal and in view of her persistent itching, it was recommended that she started ursodeoxycholic acid (UDCA), but this was declined
Summary
We report a case of severe early onset reoccurring intrahepatic cholestasis of pregnancy (ICP) in a patient with exacerbation of familial combined hyperlipidaemia (Fredrickson/WHO type V). At her booking visit at 10 weeks gestation clinical examination was unremarkable and her body mass index was normal In view of her past obstetric history a baseline liver function test (LFT) and fasting bile acid assay (BA) was carried out. At 22 weeks her fasting BA assay increased to the upper limit of normal (9 μmol/L), her LFT remained normal and in view of her persistent itching, it was recommended that she started ursodeoxycholic acid (UDCA), but this was declined. She continued on piriton tablets 4 mg 8 hourly. Her lipid profile was assessed on day 3, 5, 9 and 6 weeks postpartum (Table 1)
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