Search

Itching sensation can occur in up to 20% of pregnant women. The paper considers the most common causes of the development of this unpleasant symptom in women expecting a baby, such as polymorphic and atopic dermatitis, intrahepatic cholestasis, pemphigoid. Modern epidemiological data are presented, the clinical features of each nosology are described, and recommendations for effective treatment of these conditions are given.

Objectives : The purpose of this study is to investigate the effect of eating Saengshik and applying Hwangryunhaedok-tang on skin for pregnant woman diagnosed as Pruritus Gravidarum. Methods : This case study was done on 5 Pruritus Gravidarum patients who had visited Korean Medicine Clinic. All the patients are treated with Saengshik and Hwangryunhaedok-tang was applied on their skin. VAS(Visualanalogue scale) and photographs were used to evaluate the symptom change. Results & Conclusion : Most symptoms of patients were improved in this study. Saengshik and Hwangryunhaedok-tang can be effective in patients who were diagnosed as Pruritus Gravidarum

BACKGROUND: Physiological skin changes are common during pregnancy in addition to cutaneous disease specific to pregnancy. Dermatoses specific to pregnancy are important to recognize because they are intensely pruritic or painful to mother and may pose significant risk to patients, her fetus or both. AIM: To study the dermatological diseases in pregnancy. SETTINGS & DESIGN: Study was undertaken on pregnant women who visited the dermatology OPD of the Christian medical college and Hospital, Ludhiana. MATERIAL AND METHODS: Screening for cutaneous disorders was undertaken in two hundred pregnant women attending the dermatology OPD in Christian medical college and hospital. STATISTICAL ANALYSIS USED: Was done by using SPSS version. RESULTS: Pruritus was present in 61.5% patients. Specific pregnancy dermatoses were seen in 33% and included prurigo gestationis, pruritic urticarial papules and plaques of pregnancy (PUPP) and pruritus gravidarum. Sexually transmitted diseases accounted for 10.5%; condyloma accuminatum was the commonest STD. Commonest dermatological disorder observed was eczema with 10.5% of cases. CONCLUSION: Pregnant women are prone to suffer from a wide range of dermatological and sexually transmitted diseases. Some of these are distressing to mother, others may associated with significant fetal risk.

Five hundred pregnant women attending obstetrics OPD were screened for the presence of pruritus. The patients with other dermatological causes of pruritus (other than specific dermatosis of pregnancy) were excluded from the study. The selected patients were further subjected to routine laboratory investigations including liver function tests and IIBs Ag detection. The prevalence of pruritus in pregnancy was found to be 4.6% (23 cases). Ten patients were found to have specific dermatoses of pregnancy, including four cases of pruritus gravidarum and four of pruritic urticarial papules and papules of pregnancy. The prevalence of pruritus gravidarum was 0.8% of pregnancies. All the patients with pruritus gravidarum were primigravidae and had no clinical overlap with other specific dermatoses of pregnancy, jaundice, or intrahepatic cholestasis. One case of perinatal death was recorded among the pruritus gravidarum cases. This study has been helpful in determining the prevalence and severity of pruritus gravidarum in South India.

Until now, biochemical parameter for diagnosis of intrahepatic cholestasis of pregnancy (ICP) mostly used is the rise of total serum bile acids (TSBA) above the upper normal limit of 11 μM. However, differential diagnosis is very difficult since overlapped values calculated on bile acids determinations, are observed in different conditions of pregnancy including the benign condition of pruritus gravidarum. The aim of this work was to determine the better markers in ICP for a precise diagnosis together with parameters associated with severity of symptoms and treatment evaluation. Serum bile acid profiles were evaluated using capillary electrophoresis in 38 healthy pregnant women and 32 ICP patients and it was calculated the sensitivity, specificity, accuracy, predictive values and the relationships of certain individual bile acids in pregnant women in order to replace TSBA determinations. The evaluation of the results shows that LCA and UDCA/LCA ratio provided information for a more complete and accurate diagnosis and evaluation of ICP than calculation of solely TSBA levels in pregnant women.

Intra-hepatic cholestasis of pregnancy is a cholestatic disorder characterized by i) pruritus, with onset in the third trimester of pregnancy, without any primary skin lesions, ii) elevated fasting serum bile acids > 10 μmol / L (and elevated serum transaminases), iii) spontaneous relief of signs and symptoms within two to three weeks after delivery, and iv) absence of other disease that cause pruritus and jaundice. It is believed to be a multi-factorial disease with interplay between genetic, environmental and hormonal factors. Incidence is between 0.02% to 2.4% of all pregnancies; with wide geographical variations. Maternal prognosis is usually good but can result in adverse fetal outcomes like meconium staining of amniotic fluid, fetal bradycardia and even fetal loss. Response to anti-histaminic is poor. Of all the medical therapies that have been described for the treatment for IHCP, ursodeoxycholic acid has the best response in relieving pruritus in mother, and probably has a role in preventing even the perinatal complications. Timely diagnosis and treatment is urged in order to prevent fetal complications and an early delivery between 37 to 38 weeks should be contemplated in severe cases, especially once fetal lung maturity is attained.

Background: During pregnancy profound immunologic, metabolic, endocrine and vascular changes occur, that are responsible for the changes of the skin and its appendages, both physiologic and pathologic. Aims: We undertook a clinical study to find out the frequency and pattern of skin changes in pregnant women. Methods: All consecutive pregnant women were included in the study. Results: A total of 607 pregnant women were included in this study. Of these, 303(49.9%) pregnant women were primigravida and 304(51.1%) were multigravida. Skin changes grouped into: physiological changes (all cases), specific dermatoses (22 cases) and other dermatoses affected by pregnancy (125 cases). Most common physiological changes were pigmentary alterations seen in 555 (91.4%) followed by striae seen in 484(79.7%) cases. Of the various specific dermatoses of pregnancy, pruritic urticarial papules and plaques of pregnancy (PUPPP) was the most common disorder (14 cases) followed by pruritus gravidarum (5 cases). The most common dermatoses affected by pregnancy were candidal vaginitis (17 cases), acne vulgaris (15 cases), skin tags (15 cases), eczemas (14 cases). Conclusion: This study brings into focus various skin changes during pregnancy in south India.

Fifty-nine consecutive pregnant women complaining of pruritus without obvious dermatological cause were studied. In 57 women the presence in serum of an abnormal lipoprotein, LP-X, characteristic conditions associated with cholestasis, was verified by an immunological technique. These 57 women were designated as having cholestasis of pregnancy. Clinical symptoms were related to liver function tests: serum bilirubin, alkaline phosphatase, SGOT and SGPT. Compared with women with uncomplicated pregnancy, these patients showed a high frequency (p 1.2 mg/100 ml and/or SGOT and SGPT >50 units/1, were called hepatosis of pregnancy (HP), while 37 cases with pruritus gravidarum (PG) represented a milder degree of ch...

Estriol metabolism was studied in 23 patients with pruritus gravidarum and eight patients with recurrent jaundice of pregnancy by determining the urinary excretion of the four known estriol conjugates. Comparison of the results with those obtained in normal pregnant women revealed marked changes in estriol metabolism in the two cholestatic conditions. These include a decrease in the urinary excretion of estriol-3-glucuronide and an increase in the proportions of urinary estriol-3-sulfate, 16-glucuronide and estriol-3-sulfate. These changes are considered to be secondary to the cholestasis and are mostly due to impaired enterohepatic circulation of estrogens. The results are thus consistent with the view that although pruritus gravidarum and recurrent jaundice of pregnancy are not caused by a primary abnormality of estrogen metabolism, they probably represent an abnormal reaction of the liver to the elevated estrogen levels produced in pregnancy in susceptible women.

Case studies of 7 jaundiced women who had been taking the oral contraceptive Anovlar for less than a year are presented and discussed. Liver biopsy showed histological changes similar to those found in chlorpromazine-induced jaundice. 2 of the women had previously suffered from icterus and pruritus gravidarum and histories of these conditions should be regarded as contraindications of oral contraceptive use. It is tentatively concluded that oral contraceptives can induce a drug-type jaundice.

The skin almost always shows changes during pregnancy. Some of these alterations are so predictable as to be considered normal. Not nearly so common are a host of pruritic dermatoses, including pruritus gravidarum, herpes gestationis, pruritic urticarial papules and plaques of pregnancy, Spangler 's papular dermatitis of pregnancy, and impetigo herpetiformis. Some of these conditions can cause maternal and/or fetal complications and even death; others, although benign and transient, add to the stress of pregnancy. Physician adeptness at diagnosing and treating skin diseases specific to or affected by pregnancy is thus of vital importance in caring for pregnant women.

performed in six of the cases with histological changes very similar to those seen in chlorpromazine-induced jaundice. The laboratory findings were a normal or only slightly raised alkaline phosphatase value and high transaminase levels. Certain features in the history were present in several cases : two had suffered from icterus and pruritus gravidarum, and this should be regarded as a contraindication to the use of contraceptive pills. The widespread use of oral contraceptives leads us to the supposition that this cause for jaundice is sometimes overlooked. REFERENCES

The prevalence of intrahepatic cholestasis of pregnancy was studied immediately postpartum in 869 women from three distant Chilean cities differing in climate and food supply. Cholestatic jaundice of pregnancy was detected in 2.4% and pruritus gravidarum in 13.2%, without significant differences between the three cities. Every woman was then ethnically classified as predominantly Caucasoid, Araucanian Indian, or Aimara Indian. A significantly higher prevalence of cholestatic jaundice of pregnancy (5.5%) and pruritus gravidarum (22.1%) was found in Araucanians than in Caucasoids (2.5% and 12.6% respectively) or in the Aimaras (0 and 11.8% respectively). The prevalence of intrahepatic cholestasis of pregnancy in Araucanians increased directly with the degree of "ethnic purity." Recurrence of the disease in multiparous women was also greater in Araucanians (13.8%) than in Caucasoids (5.5%) or in the Aimaras (3.9%). We propose that an ethnic predisposition to develop intrahepatic cholestasis of pregnancy is present in Araucanian women and that the high prevalence of the disease in Chile is mainly influenced by ethnic admixture with this South American Indian (ethnic) group.

Estrogen metabolism in recurrent jaundice of pregnancy (RJP) and pruritus gravidarum (PG) was studied by determining 12 different estrogens in bile and urine. A uniformly marked fall in the biliary concentrations of all estrogens was observed in RJP. This would suggest that the enterohepatic circulation of these steroids is impaired and offers an explanation for the abnormal pattern of urinary estrogens observed in the two related syndromes. The relative excretion (= percentage of total estrogens) of estriol6 and 16-epiestriol in urine was diminished, whereas that of their respective precursors, 16α-hydroxyestrone and 16β-hydroxyestrone was increased. Rather small or insignificant changes were seen in the urinary excretion of other estrogens. Hence the main alterations occurred in the 16-hydroxylation pathways and included decreased conversion of 16α-hydroxyestrone to estriol and of 16β-hydroxyestrone to 16-epiestriol. The primary cause of these alterations is most likely the decreased biliary ex...