It’s also called obstetric cholestasis. It typically presents with itching[2] and can lead to complications for both mother and baby. Some causes of cholestasis are easy to treat. Cholestasis of pregnancy is also known as intrahepatic cholestasis of pregnancy or obstetric cholestasis. It is more common if you are from certain ethnic groups, such as South Asians and Araucanian Indians. The itching is reportedly more intense at night, after sunset. Intrahepatic cholestasis of pregnancy (also called ICP or cholestasis of pregnancy) is the most common liver condition that happens during pregnancy. Br J Obstet Gynaec 1988;95:1137- 1143. The rash of ICP is caused by scratching the intensely itchy skin. There is no rash. Others may be more serious. ICP recurs in between 60% and 90% of subsequent pregnancies. The persistence and intensity of associated pruritus are uncomfortable, and the increased risk of stillbirth is a significant concern to both patients and healthcare professionals. You’ll need to treat any disease or infection if you have one. If you’re pregnant, your doctor may give you a drug called ursodeoxycholic acid. Cholestasis sometimes starts in early pregnancy. It most commonly appears two to four weeks after the onset of itching. Intrahepatic Cholestasis of Pregnancy (ICP), (formerly known as Obstetric Cholestasis or OC), ... ICP is only completely confirmed when symptoms disappear and liver tests go back to normal after delivery. CS1 maint: multiple names: authors list (, progressive familial intrahepatic cholestasis, Pruritic urticarial papules and plaques of pregnancy, "Pruritus in pregnancy: A study of anatomical distribution and prevalence in relation to the development of obstetric cholestasis", "A comprehensive analysis of common genetic variation around six candidate loci for intrahepatic cholestasis of pregnancy", "An expanded role for heterozygous mutations of ABCB4, ABCB11, ATP8B1, ABCC2 and TJP2 in intrahepatic cholestasis of pregnancy", "Prognostic and mechanistic potential of progesterone sulfates in intrahepatic cholestasis of pregnancy and pruritus gravidarum", "Role of multidrug resistance P-glycoproteins in cholesterol esterification", "Intrahepatic cholestasis of pregnancy: recent advances", "Low serum selenium concentration and glutathione peroxidase activity in intrahepatic cholestasis of pregnancy", "Detection of additional abnormalities or co-morbidities in women with suspected intrahepatic cholestasis of pregnancy", "Ursodeoxycholic acid versus placebo in the treatment of women with intrahepatic cholestasis of pregnancy (ICP) to improve perinatal outcomes: protocol for a randomised controlled trial (PITCHES)", "Pharmacological interventions for treating intrahepatic cholestasis of pregnancy", "Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results of aggregate and individual patient data meta-analyses", "Intrahepatic cholestasis of pregnancy: Relationships between bile acid levels and fetal complication rates", "Fetal mortality associated with cholestasis of pregnancy and the potential benefit of therapy with ursodeoxycholic acid", E A Fagan "Intrahepatic cholestasis of pregnancy", Pruritic urticarial papules and plaques of pregnancy (PUPPP), Childbirth-related posttraumatic stress disorder, Esophageal intramural pseudodiverticulosis, Small bowel bacterial overgrowth syndrome, https://en.wikipedia.org/w/index.php?title=Intrahepatic_cholestasis_of_pregnancy&oldid=995686617, Maternal disorders predominantly related to pregnancy, Creative Commons Attribution-ShareAlike License. But it doesn't hurt to try these soothing tips: 1. Most women with this condition present in the third trimester (although it can present as early as seven weeks) with itching without a rash. If the problem starts inside your liver, it’s called intrahepatic cholestasis. But your doctor can treat it. Babies who get cholestasis may show signs of jaundice 3 to 6 weeks after they’re born. This causes itching and yellowing of your skin, eyes, and mucous membranes (jaundice). Health 2013;5:96-101. Intrahepatic cholestasis of pregnancy, also called obstetric cholestasis, is estimated to occur in 1 to 2 pregnancies per 1,000 in the United States. Cholestasis is a buildup of bile, something our bodies make to help digest food, in the blood. Obstetric cholestasis is a rare condition that only affects you if you are pregnant. 30(11):1342-1346. Intervention(s) In vitro fertilization–embryo transfer, management of hyperstimulation syndrome, and cholestasis of pregnancy. Some causes of cholestasis may need long-term dietary and medical treatment. Cholestasis of pregnancy is a condition that slows or stops the normal flow of bile in the gallbladder. Acta Obstet Gynecol Scand 2012;91:679-685. They also may need a liver transplant at some point. [7] Genetic mutations in the hepatocellular transport protein ABCB4 (MDR3), which controls secretion of phosphatidylcholine into bile, have been found in cases of ICP. “Cholestasis of pregnancy occurs in late pregnancy and triggers intense itching, usually on the hands and feet but often on many other parts of the body. Your doctor will ask about your health history. It slows or stops the normal flow of bile from the gallbladder. Terms of Use. You can get cholestasis when your bile doesn’t flow the right way. It's also known as intrahepatic cholestasis of pregnancy, or ICP, and can be harmful if left untreated. (15) The most common presenting symptom is pruritus — an unpleasant sensation that evokes the desire to itch. You may get yellow skin and eyes or dark pee. Cholestasis causes bile and bilirubin to build up in your bloodstream. You may need to switch to a different medicine. Cholestasis is more common in the last trimester of pregnancy when hormones are at their peak, but it usually goes away within a few days after delivery. Oatmeal baths, creams or lotions, which may soothe the skin 3. The itching is typically severe and worst at night. However, there are instances when itching may be a symptom of ICP. [18] This, plus pruritus of palms and soles, could be considered as potentially diagnostic of ICP but only with elevated bile acid levels (however LFTs are not always elevated in ICP patients). You can get cholestasis at any age. It typically presents with itching and can lead to complications for both mother and baby. Pregnancy and itching It is important that if you are pregnant and itching, you should check with your doctor or midwife. Cholestasis of pregnancy affects up to 1 percent of pregnant women in the United States. If you are of South Asian origin, it affects about 1 in 67 pregnancies. In that case, it's called cholestasis of pregnancy. [14], Consequently, both genetic mutations in hepatocyte proteins involved in bile secretion together with inhibition of those proteins by high levels of hormone metabolites in pregnancy may have roles in the pathogenesis of ICP.[6]. Fisk NM, Storey GN: "Fetal outcome in obstetric cholestasis. There's no cure for ICP, but it should go once you've had your baby. Home remedies may not offer much relief for itching due to cholestasis of pregnancy. Cholestasis of pregnancy can make you intensely uncomfortable but poses no long-term risk to an expectant mother. Diagnosis of ICP is usually based on pruritus occurring during pregnancy that is associated with elevated serum aminotransferase and/or serum bile acids, after other causes of liver test abnormalities have been excluded. About 1 or 2 out of 1,000 pregnant women will get it. This is the most common symptom. To keep you and your baby safe, you may need to have your baby around 37 or 38 weeks. Cholestasis in Pregnancy Page 6 of 11 Obstetrics & Gynaecology Cholestasis in pregnancy Background Obstetric cholestasis is a multifactorial condition of pregnancy characterised by pruritus in the absence of skin rash with abnormal liver function tests (LFTs) neither of which has an alternative cause and both of which resolve after birth. Cholestasis of pregnancy, also known as obstetric cholestasis or intrahepatic cholestasis of pregnancy, can cause severe itching, especially on the hands and feet. Obstetric Cholestasis symptoms long after pregnancy has ended (18 Posts) Add message | Report. The most specific and sensitive marker of ICP is total serum bile acid (BA) levels greater than 10 micromol/L. The itching is often worse at night and may be so bothersome that you can't sleep.The itching is most common during the third trimester of pregnancy but sometimes begins earlier. However, we know from speaking to specialists in ICP, that a very small number of women have had to remain on UDCA where there bile acids have been in the hundreds, and then have the dosage gradually reduced to taking nothing after a week or two. You may have a higher chance of cholestasis in pregnancy if you: You are more likely to get ICP in your second or third trimester. It can help your liver work better and lower the bile in your blood. You may also hear it referred to as intrahepatic cholestasis of pregnancy (ICP). Maternal consequences include the following: In most cases induction is typically recommended anywhere from 34–39 weeks. It can also help you work with your doctor to treat it. If that doesn’t work, your doctor may want you to give birth early. That’s an orange-yellow pigment your body makes when your red blood cells break down. Cholestasis of pregnancy can cause complications for both the expectant mother and baby. ©1996-2020 MedicineNet, Inc. All rights reserved. It can cause severe itching. Your baby can breathe on her own by then. ICP occurs most commonly in the third trimester, but can begin at any time during the pregnancy. [7], Estrogens, and particularly glucuronides such as estradiol-17β-D-glucuronide, have been shown to cause cholestasis in animal studies, by reducing bile acid uptake by hepatocytes. Intense itching is the main symptom of cholestasis of pregnancy. Cholestasis of pregnancy, also known as obstetric cholestasis, is a liver disease of pregnancy associated with raised serum bile acids and increased rates of adverse fetal outcomes. 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.[9][20]. To obtain a diagnosis of ICP, a liver function test and a serum bile acid test should be requested. The goals of treating cholestasis of pregnancy are to relieve itching and prevent complications for your developing baby. You may bleed more if you get extremely low in vitamin K. You may lose weight. Inflammation of the bile ducts -- pipes that transport bile (primary biliary cholangitis), Antibiotics (such as the combination medicine, Have a mother or sister who had cholestasis or ICP, Are Scandinavian, Indian, Pakistani, or Chilean, Take medications to lower bilirubin, a type of waste in the bloodstream. It has been reported that the incidence of ICP is higher in winter than summer. How common is cholestasis of pregnancy? 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