Hypertension in pregnancy:
Hypertension in pregnancy includes chronic hypertension, preeclampsia and pregnancy induced hypertension. A normal blood pressure in pregnancy is less than 140/90mmHg. Taking medication before, during and after pregnancy to maintain blood pressure below this threshold can help to reduce the risk of complications. Please consult the ‘medications’ section for advice on anti-hypertensive medications that are safe in pregnancy and breastfeeding.
For women who have booked their pregnancy care at UCLH and have a hypertensive condition in pregnancy, there is a dedicated pregnancy hypertension clinic on Tuesday and Friday mornings. Women can be referred through the ‘refer a patient’ section.
Resources:
Hypertension in pregnancy: diagnosis and management (NICE).
Intrahepatic cholestasis
Intrahepatic cholestasis is a condition that affects the liver during pregnancy and is caused by the build-up of bile acids. It typically presents in the third trimester with itching, worse at night and affecting the palms of the hands and soles of the feet.
Medication can be prescribed to help with the symptoms of intrahepatic cholestasis but, otherwise, delivery is the cure. Earlier delivery may be recommended but the timing is dependent on the bile acid concentration.
Please see below for the updated guidance from the RCOG on the diagnosis and management of intrahepatic cholestasis.
Resources:
Intrahepatic cholestasis of pregnancy (Green-top Guideline No. 43)
Acute fatty liver disease in pregnancy
Acute fatty liver disease in pregnancy (AFLP) is a rare and serious condition presenting in the third trimester of pregnancy. A diagnosis of AFLP is based on a score of 6 or more using the Swansea criteria. Delivery should be expedited once complications that include coagulopathy and metabolic derangements have been treated.
Please see below for the updated clinical recommendations from the European Association for the Study of the Liver that includes a section on AFLP.
Resources
EASL Clinical Practice Guidelines on the management of liver diseases in pregnancy