Intrahepatic cholestasis of pregnancy (ICP) is a liver disorder that occurs in late pregnancy. This condition negatively affects the release of bile (a digestive fluid) from liver cells, leading to the buildup of bile in the liver and causing its dysfunction.
Cholestasis of pregnancy (as it is usually called) triggers intense itching, but without rash. The itching usually occurs on the hands and feet, but may also affect other areas of the body. Ordinarily, itching is common in pregnancy.
Usually, it is thought to be due to raised levels of certain chemicals in the blood, such as hormones. Over time, as your bump grows, your abdominal skin is stretched and may also feel itchy. Intense itching can be a sign of a liver condition, intrahepatic cholestasis of pregnancy, and needs medical attention.
ICP affects 1 in every 140 pregnant women in the UK, about 1 or 2 in every 1,000 pregnant women in the US, and more common in Latina women; about 5 in every 100 pregnant Latina women. Occasionally, women suffering from ICP have yellowing of the skin and eyes (jaundice).
Some studies have shown that expectant women with intrahepatic cholestasis of pregnancy (ICP) are more likely to develop gallstones sometimes in their life than women who do not experience the condition. Gallstones are hardened deposits of the digestive fluid in the gallbladder (which is a small organ under the liver).
Cholestasis of pregnancy usually occurs in the third trimester of pregnancy. One peculiar characteristic of this condition is the return of bile flow to normal after delivery of the baby and the automatic disappearance of the signs and symptoms of the condition. However, they can recur during subsequent pregnancies.
Intrahepatic cholestasis of pregnancy (ICP) can have a serious effect on the unborn baby. This condition is associated with an increased risk of premature delivery and stillbirth.
Intrahepatic cholestasis of pregnancy’s effect on the baby may be that the baby born to mothers with ICP may have a slow heart rate and lack of oxygen during delivery (fetal distress).
ICP seems to run in families but can happen with no family history. It is common in women of South Asian origin, affecting about 1 in every 70 or 80 pregnancies.
If you had intrahepatic cholestasis of pregnancy in your previous pregnancy, you can stand the risk of developing it again in subsequent pregnancies, with a 60% to 90% chance.
Babies whose mothers have ICP have a higher risk of being born prematurely or stillborn. Other factors that may increase the risk of intrahepatic cholestasis of pregnancy (ICP) include being pregnant with twins or more, history of liver damage or disease.
Intrahepatic cholestasis of pregnancy is a potentially serious liver disorder that can develop in pregnancy. Its emergence can lead to other potential complications if overlooked. There is no cure for ICP, though it can disappear on its own after delivery. But the risk of possible induced labor, premature delivery or stillborn baby does not without complications. Intrahepatic cholestasis of pregnancy (ICP) can affect fat absorption in pregnant women, which can result in a low level of vitamin K responsible for blood clotting. Babies can have lung problems (fetal distress).
When carrying out the diagnosis of intrahepatic cholestasis of pregnancy, the following should be considered:
- Medical history.
- Family history.
INTRAHEPATIC CHOLESTASIS OF PREGNANCY TREATMENT
Talk with your doctor. Do not take any medication without your doctor’s consent.
The prescribed treatments of intrahepatic cholestasis of pregnancy may include:
- Blood tests; to check the bile acid levels and liver function.
Ursodiol (Actigall and Urso) helps in lowering lower the amount of bile acids in your blood, relieves itching skin, and may help in reducing the risk of your body having complications caused by intrahepatic cholestasis of pregnancy (ICP).
Do not use antihistamines or corticosteroid creams or lotions to help relieve itching. They work in ICP itching and may harm your baby during pregnancy.
- Creams; aqueous cream with menthol, to relieve itching.
- Medicine; ursodeoxycholic acid (UDCA), to reduce bile acids and ease itching.
This may make you feel better. Don’t take any over-the-counter medications during pregnancy without discussing it with your doctor first.
- Soaking in a bath with lukewarm water.
Monitoring During Pregnancy
Your doctor may monitor your baby with tests like:
Here, an ultrasound is used to check your baby’s amniotic fluid for meconium or find out if your baby’s lungs are developed for birth.
- Your doctor may recommend inducing labor to help prevent complications like stillbirth.
This is also medically known as a non-stress test (NST). The test checks your baby’s heart rate in the womb, heart rate changes, and oxygen supply to the body.
- Fetal Heart Rate Monitoring
This test combines a non-stress test with an ultrasound. BPP finds out how much amniotic fluid is in your womb and checks your baby’s muscle tone and movements.
Without proper treatment, intrahepatic cholestasis of pregnancy (ICP) may lead to seizures, coma, stroke, or brain damage. In severe cases and if left untreated, increased ICP can incur harm on the body and even be fatal. Rapid intervention and treatment may improve a person’s outlook. Making a full recovery with timely treatment is possible.
- Biophysical Profile (BPP)
INTRAHEPATIC CHOLESTASIS OF PREGNANCY SYMPTOMS
The symptoms of intrahepatic cholestasis of pregnancy usually start around 30 weeks of pregnancy. These may include:
This usually occurs without rash. More noticeable on the hands and feet, but can be all over the body. This may get worse at night. Itching is the main symptom of ICP.
- Pale poop.
- Dark urine.
- Loss of appetite.
- Yellowing of the skin and eyes (jaundice).
Jaundice is a rare symptom of ICP. Itching can be stressful, causing irritation and discomfort (especially at night). Wearing loose clothing may help reduce your discomfort.
INTRAHEPATIC CHOLESTASIS OF PREGNANCY CAUSES
The cause of intrahepatic cholestasis of pregnancy (ICP) is not vivid. There is evidence of genetic involvement. Sometimes, the condition runs in families. Certain genetic variants have also been identified.
Genetic changes in the ABCB-11 or the ABCB-4 gene can increase a woman’s chances of developing ICP. Pregnancy hormones also may play a role. As the pregnancy hormones rise, the closer you get to your due date. This may affect the normal flow of bile.
There may be certain environmental factors. There are more diagnoses during winter and autumn. Cold or hot weather affects ICP increasingly.
How serious is cholestasis in pregnancy?
Cholestasis of pregnancy may increase the risk of fetal distress, premature birth, or stillbirth. A developing baby depends on the mother’s liver to remove bile acids from the blood, therefore, the high levels of maternal bile cause stress on the baby’s liver.
What causes intrahepatic cholestasis of pregnancy?
Intrahepatic cholestasis happens when there is a problem with the elimination of bile salts from the liver. This is the kind of cholestasis that happens during pregnancy and is thought that pregnancy hormones (especially additional estrogen) may affect the proper functioning of the gallbladder and the liver.
Genetic and environmental conditions may also be involved. ICP occurs higher during the winter and autumn seasons, as well as in hot and cold weathers.
How common is stillbirth if you have cholestasis?
Intrahepatic cholestasis of pregnancy (ICP) increases the risk of stillbirth, more often than not. Patients affected by ICP have a higher stillbirth probability when compared to patients without the condition. The stillbirth rate at 37 weeks gestation and beyond, for the entire population in the United States, is approximately 0.1% to 0.3%.
Is delivery by 37 weeks necessary for cholestasis of pregnancy?
Because of the increased risk of stillbirth in the sitting of ICP, induction of labor is often recommended at 37 weeks of gestation to balance the risk of iatrogenic premature delivery against the risk of fetal mortality.
Can cholestasis kill a baby?
In the cholestasis of the liver, bile leaks into your bloodstream and slowly poisons your blood and causing terrible itching your urine and poop may be discolored, and sometimes accompanied by jaundice (yellow of the skin and whites of the eyes). More important, it can immediately kill babies.