Intrahepatic cholestasis of pregnancy (ICP), also known as obstetric cholestasis, cholestasis of pregnancy, jaundice of pregnancy, and prurigo gravidarum, is a medical condition in which cholestasis occurs during pregnancy. It typically presents with troublesome itching and can lead to complications for both mother and fetus. The causes of intrahepatic cholestasis of pregnancy are still not fully understood. Hormones and genetic factors are likely to be important in the pathogenesis of the disease. A number of features of the disease suggest a link to hormones. There is very minimal risk for mother, but for fetus the risk of being born prematurely is significantly greater if the mother has cholestasis of pregnancy.
Early signs and symptoms
Most women with this condition present in third trimester with itching without a rash. Typically, the itching is localized to the palms of the hands and soles of the feet but can be anywhere on the body. Hallmarks of ICP include the following symptoms: Itching, in particular but not limited to that of the palms of the hands and soles of the feet, without presence of a rash Itching that increases in the evening Itching that does not respond favorably to anti-histamines or other anti-itch remedies Often, elevated LFT results as well as serum bile acid counts
Cholestasis of pregnancy 28.7 yrs (20-37), Primiparous (%)-68.9, Multiparous (%)-31.1.
To obtain a diagnosis of ICP, there are two Liver Function Tests and Serum bile acid test. The liver function tests (LFTs) is a simple blood test, the results of which should be available by the next day. The serum bile acid blood test for ICP is a quantitative measurement of bile salts. The results of this test often take longer to return, but the test is more specific for ICP.
Upon diagnosis, many providers will prescribe Ursodeoxycholic Acid. While there is no cure for ICP, and no way to guarantee a successful outcome, studies have shown a slightly better fetal and maternal outcome from administration of Ursodeoxycholic Acid, whereas Cholestyramine appears to only relieve itching. If additional blood tests to check clotting function identify a problem, giving Vitamin K may help avoid the risk of hemorrhage at delivery.
Action Medical Research is one of the research center that works on Intrahepatic cholestasis of pregnancy. They have studied the proteins that control the levels of bile acids in the blood. Their results should aid the development of treatments for the condition and help doctors to predict and minimize the risk of fatal consequences for the unborn baby.