While providing care for Sari a number of clinical management issues arise. Firstly, Sari’s pregnancy was conceived through intrauterine insemination (IUI), risks associated with artificial reproductive technologies were likely reviewed with Sari and Jane prior to intervention . It is important that the midwife be aware of potential risks associated with this method of conception and able to review these with Sari and Jane if they have questions. IUI can include increased risks of preterm birth, low birth weight, small for gestational age, and placenta previa when compared to spontaneous conception. (1:1130,1115) Sari also describes a history of depression and treatment, which warrants close monitoring of mental health status in the current
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The midwifery team should be well informed to be able to answer questions in a supportive role. Incidence rates of ICP vary with geography and ethnicity, from less than 1% in North America and up to 4% in Chili . (11:141, 12:1-2). The cause is not well understood but it is believed to have some genetic and environmental factors. (9:178, 12:3) The genetic link is supported by the increased occurrence rates within families, ethnic and geographic variations and the high risk of reoccurrence, (60 to 70%), in subsequent pregnancies. (12:3, 13:280) Non-genetic or environmental factors include low vitamin D levels, low selenium levels, hepatitis C, multiple gestations, maternal age over 35, seasonal factors (as incidence rates increase in the winter months), and a potential hormonal component. (9:178, 11:149, 17:329) Maternal implications include varying severities of pruritus, increased risk of postpartum hemorrhage due to fat excretion from steatorrhea affecting (due to malabsorption of vitamin K absorption), long term risks of hepatobiliary cancer and autoimmune-mediated and cardiovascular diseases, and risk of reoccurrence. (9:183, 17:331) The fetal implications include increased rates of spontaneous and iatrogenic preterm labour, fetal asphyxia events, meconium stained amniotic fluid, and stillbirth. (11:142, 17:329) The severity of fetal implications is related to the level of maternal serum bile acid levels, with “severe” levels classified as >40 μmol/L. (9:183, 17:329,
The midwifery team should be well informed to be able to answer questions in a supportive role. Incidence rates of ICP vary with geography and ethnicity, from less than 1% in North America and up to 4% in Chili . (11:141, 12:1-2). The cause is not well understood but it is believed to have some genetic and environmental factors. (9:178, 12:3) The genetic link is supported by the increased occurrence rates within families, ethnic and geographic variations and the high risk of reoccurrence, (60 to 70%), in subsequent pregnancies. (12:3, 13:280) Non-genetic or environmental factors include low vitamin D levels, low selenium levels, hepatitis C, multiple gestations, maternal age over 35, seasonal factors (as incidence rates increase in the winter months), and a potential hormonal component. (9:178, 11:149, 17:329) Maternal implications include varying severities of pruritus, increased risk of postpartum hemorrhage due to fat excretion from steatorrhea affecting (due to malabsorption of vitamin K absorption), long term risks of hepatobiliary cancer and autoimmune-mediated and cardiovascular diseases, and risk of reoccurrence. (9:183, 17:331) The fetal implications include increased rates of spontaneous and iatrogenic preterm labour, fetal asphyxia events, meconium stained amniotic fluid, and stillbirth. (11:142, 17:329) The severity of fetal implications is related to the level of maternal serum bile acid levels, with “severe” levels classified as >40 μmol/L. (9:183, 17:329,