In brief — the direct answer
Intrahepatic Cholestasis of Pregnancy (ICP), also known as obstetric cholestasis, is a liver disorder that occurs in late pregnancy. It causes an accumulation of bile acids in the mother's blood, most notably characterized by intense itching. While ICP is primarily uncomfortable for the mother, the elevated bile acids can be dangerous for the baby, increasing the risk of preterm birth and, in severe cases, sudden stillbirth. At the MFM Unit, we prioritize rapid diagnosis and intensive monitoring for mothers with ICP.
What is Cholestasis of Pregnancy (ICP)?
Bile is a fluid made by the liver that helps with digestion. During pregnancy, hormones can slow down the normal flow of bile out of the liver. This causes bile acids to build up in the liver and eventually spill over into the mother's bloodstream. These extra bile acids are what cause the intense, relentless itching and can cross the placenta, potentially affecting the baby's heart rhythm.
Who is at risk?
ICP is more common in:
- Individual/Family History: If you or your mother/sister had it.
- Multiple Pregnancies: Women carrying twins or triplets.
- Liver Conditions: History of hepatitis or gallstones.
- Season/Ethnicity: ICP is more frequent in certain ethnic groups and has been noted to increase in winter months in some regions.
How we diagnose it
The diagnosis is based on symbols and blood work:
- Severe Itching: Specifically itching on the palms of the hands and soles of the feet that is worse at night. Critically, there is typically no rash associated with this itch.
- Bile Acid Test: The primary diagnostic test. A level over 10-19 µmol/L is considered abnormal.
- Liver Function Tests (LFTs): Checking for elevated liver enzymes (ALT/AST).
What does management involve?
Once diagnosed, we focus on both relief and fetal safety:
- UDCA (Ursodeoxycholic Acid): The main medication used to help lower bile acid levels and reduce itching.
- Topical Creams: Aqueous cream with menthol may provide temporary relief for the skin.
- Frequent Testing: Bile acids are re-checked weekly or twice weekly, as the levels can fluctuate or rise suddenly.
- Fetal Monitoring: Frequent CTG (heart rate) monitoring, although bile acid levels are the primary guide for safety.
What are the outcomes?
The management goal is a healthy birth near term:
- Timed Delivery: Because the risk of sudden stillbirth increases as the pregnancy reaches full term, we usually recommend delivery by 37 to 38 weeks. If bile acid levels are very high (over 100), delivery may be even earlier.
- Postpartum: ICP resolves almost immediately after the baby is born. Liver function tests and bile acid levels usually return to normal within 6-12 weeks.
- Future Risk: There is a high chance (60-90%) that ICP will return in future pregnancies.
When to see a subspecialist
If you experience itching that is worse at night and affects your hands and feet, do not dismiss it as 'normal pregnancy skin stretching.'
Our maternal medicine specialist, Dr. Maria Haji Liga, provides expert care for ICP. We ensure that your bile acid levels are tracked with the highest accuracy and that your delivery plan is optimized for your baby's safety.
Questions to ask your doctor
References & Clinical Guidelines
- Obstetric Cholestasis (Green-top Guideline No. 43)
- Intrahepatic cholestasis of pregnancy: consensus and management (Consult Series)
- Ursodeoxycholic acid versus placebo in women with intrahepatic cholestasis of pregnancy (PITCHES trial)