Saturday, May 16, 2009

Intrahepatic Cholestasis of Pregnancy

What is obstetric cholestasis (intrahepatic cholestasis of pregnancy – ICP)?

Obstetric cholestasis (sometimes called "cholestasis of pregnancy", "OC", "intrahepatic cholestasis of pregnancy", "ICP") affects the liver, which in some women seems to be oversensitive to pregnancy hormones. Bile is produced in the liver and normally it flows down the bile ducts into the intestines where it helps with the digestion of food. If you have OC, the flow of bile into the intestines is reduced and so bile salts build up in your blood.

What are the symptoms of Cholestasis of pregnancy?
  • Itching, particularly on the hands and feet (often is the only symptom noticed)
  • Dark urine color
  • Light coloring of bowel movements
  • Fatigue or exhaustion
  • Loss of appetite
  • Depression
Less common symptoms include:
  • Jaundice (yellow coloring of skin, eyes, and mucous membranes)
  • Upper-Right Quadrant Pain
  • Nausea

Who is at risk for Cholestasis of pregnancy?
1 to 2 pregnancies in 1000 are affected by cholestasis. The following women have a higher risk of getting cholestasis during pregnancy:

  • Women carrying multiples
  • Women who have previous liver damage
  • Women whose mother or sisters had Cholestasis

How is OC identified?
A diagnosis of cholestasis can be made by doing a complete medical history, physical examination, and blood tests that evaluate liver function, bile acids, and bilirubin.

Will OC harm my baby?
The risk of having a stillborn baby is 15 per cent greater for women who have OC than for other women. Nobody is quite sure why. The baby may die because of the bile acids, which are known to cross the placenta, or as a result of being suddenly deprived of oxygen, perhaps because of placental problems.

ICP/OC has been reported to be associated with an increased risk of spontaneous premature birth, fetal distress and stillbirth. With active management (which usually means treatment and choosing to deliver early) the risk of stillbirth in an ICP/OC pregnancy is believed to be the same as that for a normal pregnancy (1%). Most hospitals chose to monitor women with ICP/OC more closely and to deliver the babies early in order to minimize any risk to your baby.

How is OC managed?
The treatment goals for cholestasis of pregnancy are to relieve itching. Some treatment options include:
  • Topical anti-itch medications or medication with corticosteroids
  • Medication to decrease the concentration of bile acids such as ursodeoxycholic acid
  • Cold baths and ice water slow down the flow of blood in the body by decreasing it’s temperature
  • Dexamethansone is a steroid that increases the maturity of the baby’s lungs
  • Vitamin K supplements administered to the mother before delivery and again once the baby is born to prevent intracranial hemorrhaging
  • Dandelion Root and Milk Thistle are natural substances that are beneficial to the liver
  • Bi-weekly non-stress tests which involve fetal heart monitoring and contraction recordings
  • Regular blood tests monitoring both bile serum levels and liver function
Treatment for cholestasis of pregnancy needs to be determined by your physician who will take the following criteria into consideration:
  • Your pregnancy, overall health, and medical history
  • The extent of the disease
  • Your tolerance of specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • Your opinion or preference
Treatments that should not be used for Cholestasis include:
  • Antihistamines
  • Aveeno and Oatmeal Bath
*There are conflicting views on using the medication Cholestyramine for treatment of cholestasis. In the past, this medication was readily used to treat this condition, but some studies have shown that Cholestyramine may not be as effective as other treatments and potentially has some adverse side effects such as blocking essential vitamins like Vitamin K (a vitamin that is already deficient in women with cholestasis).

Will the itching go away after delivery?
ICP is believed to be a condition caused by a gene mutation resulting in the liver's inability to cope with high levels of estrogen present in the body. However, ICP is sometimes a result of an underlying liver disorder. It is normal for patients to continue itching for some time after delivery, particularly with cases that have been prolonged or in cases where a patient has had several pregnancies in a short time frame, but special attention should be given to patients whose itching intensifies after delivery or does not go away at all. Postpartum Serum Bile Acid testing and Liver Function testing are suggested for ICP patients to ensure overall health. A differential diagnosis may include Primary Bilary Cirrhosis, Hepatitis, AIDS, anemia, Benign Recurrent Intra-hepatic Cholestasis, and bile duct obstruction.

I found this information posted by Full Circle Doulas on Facebook and


  1. Is the vitamin K to prevent hemorrhage in the baby or mother? It sounds like the baby here?

  2. Both, but the primary concern is the mother in this case:

    "Mothers with OC may be at risk of bleeding after the birth. This is because bile is needed to absorb vitamin K from food, and vitamin K helps the blood to clot. So in some hospitals the mother is given vitamin K daily by mouth until delivery to protect her from this small risk of bleeding. The baby is also protected by the vitamin K."