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."
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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







Wednesday, April 09, 2014

The NFL Expert Speaks Out On…… Cesareans?

NFL analyst Boomer Esiason couldn’t have picked a worse (or better) month in which to say “Quite frankly, I would have said ‘C-section before the season starts’” in regards to New York Mets second baseman Daniel Murphy’s decision to miss Opening Day of baseball to take paternity leave.

April is annual Cesarean Awareness Month, and while Mr. Esiason feels like a cesarean should take priority over physiologic birth, the American Academy of Family Physicians and ACOG have a different thought about scheduling an early delivery:

  • Babies will miss essential development of fat stores in week 37 and 38 that help them regulate their body temperature.
  • Brains and lungs are also still developing in week 37 and 38.
  • Early babies are more likely to develop breathing and eating problems, jaundice, cerebral palsy, sensory development issues, and require intensive care.
  • The risk of infant mortality is also higher.
  • The mother is more likely to develop postpartum depression. Specialists advise this is most likely as a result of the baby spending additional time in intensive care and not being able to bond more immediately with the mother.
  • Early induced deliveries are more likely to be risky and complicated as the mother’s body is not naturally prepared for delivery, so cesarean sections are increasingly more common.
  • Cesarean sections are major surgery. Any time a patient goes under anesthesia, not to mention undergoes surgery, there is risk for incident not only during surgery but in the recovery that follows.

The latest revised guidelines by ACOG may focus on the rising cesarean rate in the US, now standing at 31.3%.  However, in a press release on2/27/14, International Cesarean Awareness Network president, Christa Billings said ““There has been a disconnect between what medical research says and the way that hospitals and providers have practiced medicine for a long time.  These guidelines support what ICAN has been educating women on all along.  While this report is encouraging, it fails to address the nationwide problem of hospital and provider vaginal birth after cesarean (VBAC) bans.  With the primary cesarean rate at a high level, many women are seeking VBAC’s.  This important issue needs to be addressed by ACOG.”
The press release continues:
‘Part of ICAN’s stance, as outlined in their Statement of Beliefs, is that “It is unethical for a physician to recommend and/or perform non-medically indicated cesareans (elective). Women are not being fully informed of the risks of this option in childbirth, and therefore make decisions based on cultural myth and fear surrounding childbirth.” These new guidelines, as set forth by the ACOG and Society for Maternal-FetalMedicine (SMFM), are on track to help make sure that “non-medically indicated cesareans” happen less frequently and that women are given more opportunities to experience the natural process of labor and birth.
Since 2012, AWHONN (Association of Womens Health, Obstetrics and Neonatal Nursing) has promoted “Go the full 40” Campaign encouraging the natural onset of physiologic labor.  The March of Dimes has a similar campaign titled “Healthy Babies are Worth theWait.”


This demonstrates that we, as maternity health care professionals, STILL have a long way to go to reach the general public (as well as the medical establishment) with the evidence-based information.

Thursday, April 03, 2014

Top 10 Reasons Why YOU Should Attend the 2014 ICEA Convention!

Thinking about attending a conference this year?  Need CEUs or CERPs?  Well, here are the top ten reasons to attend the 2014 ICEA Convention, September 10-13!

10. What a fun get-away! We'll be touring the Biltmore Estate and having dinner there!

 9.  Great location! In breath-taking Asheville North Carolina in the fall as the leaves turn!

 8.  See old friends and meet new ones!

 7.  Network, network, network!

 6.  Get the latest evidence-based research updates plus great poster presentations!

 5.  This is an opportunity for professional immersion, with the great pre-con workshops!

 4.  View our exhibits in the Exhibit Hall - another great opportunity for learning!

 3.  Meet the ICEA Leadership, find out what we've been doing and how you can get involved!

 2.  Learn from the fantastic content brought to attendees by our......

 1.  Amazing Speakers including Dr. Sarah Buckley, Kathy Kendall-Tackett, and more!


For more information about this amazing convention, click here!  Registration opens soon!


Tuesday, April 01, 2014

Blog Carnival Deadline is 29 Days Away - no April Fool!

Each year, Childbirth Today hosts a blog carnival during the week before Mother’s Day (May 5-12, 2014). This week has also been referred to as Childbirth Education Awareness Week and May is traditionally Doula Month.

So……

If you would like to submit to the 2014 Childbirth Today Blog Carnival, here is the info!

A blog carnival is a themed collection of entries during a specific time period. 

Guest bloggers send their 500 word (evidence-based, referenced) submission to birthguru@birthsource.com no later than April 30, 2014.  The context of the submission must be childbirth (which also includes breastfeeding and the postpartum period).

Guest bloggers must provide proof of original/or permission to use photos if photos are included with the submission. Childbirth Today and Perinatal Education Associates encourages copyright protection.

Guest bloggers should also provide a 3-5 line bio of themselves, including credentials.  The addition of the guest blogger’s contact information is highly encouraged, as sometimes readers would like to speak to you directly!

Guest bloggers can be from anywhere in the world.  Submission is not limited to the US.

Submissions may be edited for punctuation and/or grammar.

We will use the first seven blog submissions during our Blog Carnival.  Should we receive more than seven (and we have in the past!), we will continue to run the submissions until all submissions have been published.

Why would you want to submit to our Blog Carnival?

Helps you to network through social media.
Assists you in honing your writing skills.
Establishes you as a birth authority and birth blogger!
Promotes your birth-related business!


Remember, 500 words by April 30!  Now…..get writing!