Summary about Disease
Intrahepatic Cholestasis of Pregnancy (ICP), also known as obstetric cholestasis (OC), is a liver disorder that occurs during pregnancy. It is characterized by intense itching, usually without a rash, and elevated levels of bile acids in the blood. It poses risks to both the mother and the fetus.
Symptoms
Intense itching, typically on the palms and soles of the feet, but can be generalized. Itching is usually worse at night.
Dark urine.
Pale stools.
Jaundice (yellowing of the skin and whites of the eyes) - less common.
Loss of appetite.
Nausea.
Fatigue.
Causes
The exact cause is not fully understood, but it is thought to be a combination of factors:
Hormones: Pregnancy hormones (estrogen and progesterone) can affect liver function and the flow of bile.
Genetics: There is a genetic predisposition. Women with a family history of ICP are at higher risk. Specific genes involved in bile acid transport are implicated.
Environmental factors: Selenium deficiency may play a role.
Medicine Used
Ursodeoxycholic acid (UDCA): This is the primary medication used to treat ICP. It helps to reduce bile acid levels in the blood and can alleviate itching.
Antihistamines: May be prescribed for symptomatic relief of itching, although they are often not very effective for the type of itching associated with ICP.
Vitamin K: May be supplemented, particularly if there are concerns about impaired absorption due to cholestasis.
Is Communicable
No, Intrahepatic Cholestasis of Pregnancy is not a communicable disease. It is a condition related to pregnancy and liver function.
Precautions
Regular monitoring: Close monitoring of liver function tests and bile acid levels.
Fetal monitoring: Frequent fetal monitoring to assess fetal well-being.
Vitamin K supplementation: As directed by your doctor.
Avoidance of liver-toxic substances: Avoid alcohol and other substances that may burden the liver.
Inform healthcare providers: Ensure all healthcare providers are aware of the ICP diagnosis.
How long does an outbreak last?
ICP typically starts in the second or third trimester of pregnancy and resolves spontaneously after delivery. The symptoms usually disappear within a few days or weeks after childbirth.
How is it diagnosed?
Medical history and physical exam: Assessing symptoms and risk factors.
Blood tests: Elevated liver function tests (ALT, AST) and elevated bile acid levels. Bile acid levels are the key diagnostic marker.
Exclusion of other conditions: Ruling out other liver diseases or causes of itching.
Timeline of Symptoms
Second or Third Trimester: Symptoms usually begin during the second or third trimester.
Gradual Onset: Itching typically starts mildly and gradually worsens over time.
Nocturnal Intensification: Itching is often more intense at night.
Resolution After Delivery: Symptoms resolve within days to weeks after childbirth.
Important Considerations
Fetal Risks: ICP is associated with increased risks of preterm labor, fetal distress, meconium staining of amniotic fluid, and stillbirth. Therefore, close monitoring and sometimes early delivery are necessary.
Recurrence: Women who have had ICP in one pregnancy are at higher risk of recurrence in subsequent pregnancies.
Active Management: Requires a team approach involving an obstetrician and potentially a hepatologist.
Delivery Timing: Delivery is often induced at or before term (typically around 37-38 weeks) to reduce the risk of fetal complications.
Postpartum Monitoring: Liver function tests should be repeated postpartum to ensure they return to normal.