How to Identify Intrahepatic Cholestasis of Pregnancy

Itching is a normal part of pregnancy for many women, and can be caused by a number of things, including stretching of the skin, hormonal changes and allergies. Constant and severe itching can sometimes be a sign of a much more serious disorder, known as Intrahepatic Cholestasis of Pregnancy.Intrahepatic Cholestasis of Pregnancy, or ICP, is a potentially life-threatening liver disorder that is caused by the abnormal flow of bile from the liver. This abnormal flow results in a build-up of bile acids in the blood, causing widespread itching. ICP usually begins during the last three months of pregnancy, but symptoms can develop as early as the first trimester. Intrahepatic Cholestasis of Pregnancy does not permanently harm the health of the mother, but is potentially fatal to the unborn baby, often resulting in premature birth, severe hemorrhaging or stillbirth. Because of this, all unexplained itching should be monitored and followed closely, and testing and treatment should begin immediately if ICP is suspected.

Difficulty: Moderately Challenging

Instructions

1. Read everything you can about normal pregnancy complaints and learn what symptoms during pregnancy may indicate a complication such as Intrahepatic Cholestasis of Pregnancy. Pregnant bodies go through a host of changes, and it is not always easy to differentiate between normal discomforts caused by your growing and changing body and abnormal signs that may require examination and diagnosis by your doctor.

2. Be alert for any symptoms of ICP, such as intense itching, upper right abdominal pain, pale stools, dark urine, yellow eyes or skin, or nausea that occurs during the second or third trimester. Itching is typically the most obvious and severe symptom of ICP--but it is also the symptom most often dismissed by many OBs. Itching associated with ICP is generally worse on the soles of the feet and palms of the hands, but may occur all over, preventing sleep and interfering with daily activities. There is no rash visible to account for the itching caused by ICP, which is one reason doctors overlook the seriousness of the symptom. Fatigue, loss of appetite and mild to severe depression are also symptoms associated with ICP.

3. Show your OB any cuts on your skin caused by your constant scratching. Be careful to note which skin cuts, scrapes or bumps were a result of the scratching, and which may have been present before the itching began. Other conditions common during pregnancy can cause widespread itching, but those conditions often present with a skin rash, bumps or lesions.

4. Speak with your OB to determine if your symptoms are normal for your stage of pregnancy, or if they warrant further investigation. Regardless of what your OB believes, if you truly think your symptoms are more than just the standard aches, pains and itches of pregnancy--insist on follow up testing.

5. Insist that the levels of bile acids in your blood are tested. One extremely important test used in the diagnosis of ICP is a serum bile acid test. Unfortunately, very few labs perform this highly specific test, which means your results may take one or more weeks to come back. When other tests, such as liver function tests and measurements of clotting time are abnormal, treatment should be started while waiting for results of the serum bile acid test.

6. Retest your serum bile acids after giving birth. Sometimes, even when Intrahepatic Cholestasis of Pregnancy is very strongly suspected, lab results come back normal or close to normal. In these cases, a diagnosis may be confirmed after delivery if symptoms disappear and test results change in any way. Because ICP is likely to recur in a future pregnancy, a diagnosis is vital to the health of any future children.

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