Intrahepatic Cholestasis of Pregnancy (ICP)

Medika Life — Fri, 29 May 2020 07:15:40 +0000

This condition may also be referred to as obstetric cholestasis, pregnancy-related cholestasis or recurrent intrahepatic cholestasis of pregnancy.

Warning

Intrahepatic cholestasis of pregnancy can cause problems for the unborn baby. This condition is associated with an increased risk of premature delivery and stillbirth. Additionally, some infants born to mothers with intrahepatic cholestasis of pregnancy have a slow heart rate and a lack of oxygen during delivery (fetal distress).

What is Intrahepatic cholestasis of pregnancy (ICP)

Intrahepatic cholestasis of pregnancy is a liver disorder that occurs in pregnant women. Cholestasis is a condition that impairs the release of a digestive fluid called bile from liver cells. As a result, bile builds up in the liver, impairing liver function. Because the problems with bile release occur within the liver (intrahepatic), the condition is described as intrahepatic cholestasis.

Intrahepatic cholestasis of pregnancy usually becomes apparent in the third trimester of pregnancy. Bile flow returns to normal after delivery of the baby, and the signs and symptoms of the condition disappear. However, they can return during later pregnancies..

Anatomy of the intrahepatic bile ducts. Intrahepatic bile ducts are a network of small tubes that carry bile inside the liver. The smallest ducts, called ductules, come together to form the right hepatic bile duct and the left hepatic bile duct, which drain bile from the liver. Bile is stored in the gallbladder and is released when food is being digested. Credit: © 2015 Terese Winslow LLC for the National Cancer Institute
Use of illustrations and other content

This condition causes severe itchiness (pruritus) in the expectant mother. The itchiness usually begins on the palms of the hands and the soles of the feet and then spreads to other parts of the body. Occasionally, affected women have yellowing of the skin and whites of the eyes (jaundice). Some studies have shown that women with intrahepatic cholestasis of pregnancy are more likely to develop gallstones sometime in their life than women who do not have the condition.

Who is affected by ICP

Intrahepatic cholestasis of pregnancy is estimated to affect 1 percent of women of Northern European ancestry. The condition is more common in certain populations, such as women of Araucanian Indian ancestry in Chile or women of Scandinavian ancestry. This condition is found less frequently in other populations.

From a genetic point of view susceptibility to intrahepatic cholestasis of pregnancy is inherited in an autosomal dominant pattern, which means one copy of the altered gene in each cell is sufficient to increase the risk of developing the disorder. Some women with an altered gene do not develop intrahepatic cholestasis of pregnancy. Many other factors likely contribute to the risk of developing this complex disorder.

Credit: U.S. National Library of Medicine

Additional Symptoms

Cholestasis can also occur in individuals that are not pregnant and can be triggered by medication, tubercolosis, metastic cancers and other factors. You may experience some, all or none of the symptoms listed below.

Symptoms may include:

Clay-colored or white stools
Dark urine
Inability to digest certain foods
Itching (Particularly in preganancy)
Nausea or vomiting
Pain in the right upper part of the abdomen
Yellow skin or eyes

Diagnosis and Treatment

Your doctor will request blood tests to check if you have elevated bilirubin and alkaline phosphatase levels. In addition, doctors can make use of any of the following diagnostic techniques

CT scan of the abdomen
MRI of the abdomen
Endoscopic retrograde cholangiopancreatography (ERCP), can also determine cause
Ultrasound of the abdomen

The underling cause of the cholestasis will be treated. If you are pregnant, the condition usually resolves on its own after you’ve given birth. Risk factors are described above and the doctor will carefully monitor your unborn child’s health, in some instances recommend pre-term delivery to reduce risk to you and your child.