Monday, April 21, 2014

Intrahepatic Cholestasis of Pregnancy - what you should know

A friend recently told me her daughter had ICP - intrahepatic cholestasis of pregnancy.  I had only heard a little about it and decided to investigate.  Here's what I found:

ICP is a pregnancy-specific liver disorder and is also called obstetric cholestasis.  First introduced in the literature in 1883, ICP was first called "recurrent jaundice in pregnancy".  Complete resolution is found with the birth of the baby, and there is a high recurrence in subsequent pregnancies.  For the mother, there is no lasting hepatic damage and symptoms resolve within
approximately 48 hours post delivery.

ICP appears to be more common in the winter months and is slightly more common in twin pregnancies and following IVF (in vitro fertilization).  According to www.icpcare.org, 1 to 2 pregnancies in 1000 is affected with ICP.

The most common initial symptom of ICP is pruritis, or the irresistible urge to scratch - specifically the palms of the hands and soles of the feet.  It can, however, affect other areas of the body.   Many women say that the itching is worse at night, so much so that it interferes with sleep. Nearly 80% of women present with itching after 30 weeks, and some have reported it as early as 8 weeks gestation. Women may also experience dark colored urine, light/gray stools, pain in the right upper quadrant of the abdomen, exhaustion and loss of appetite.

The exact etiology of ICP is unknown, although some researchers feel there is a genetic component.  Likewise, the etiology of fetal complications is also poorly understood.  Some studies have shown these questionable contributing factors as to cause:


  • Low serum selenium levels
  • Seasonal variation (more common in winter)
  • Increased incidence of hepatitis C
  • IVF
  • Possible hormonal component
  • Geographic component (higher rates seen in Scandinavia, and South America)


Since this condition is not well understood, medical management options are put in place to minimize the risk of fetal distress, preterm delivery and sudden fetal death.  Some research shows good outcomes with induction of labor between 37 and 38 weeks.  ICPCare says that "Ursodeoxycholic Acid (UDCA), also known as Actigall or Urso is currently the front-line medication for the treatment of ICP.  UDCA is a naturally occurring bile acid that improves liver function and helps reduce total bile acid concentration in the bloodstream."
\

To learn more about Intrahepatic Cholestasis, please click on the links below:

Treatment of ICP

ICP Support

ICP in the literature:

http://www.icpcare.org/images/ICPmedicalarticle.pdf

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2678574/

http://emedicine.medscape.com/article/1562288-overview







1 comment:

Skyline Spirit said...

pretty nice blog, following :)