Obstetric cholestasis, also known as intrahepatic cholestasis of pregnancy or ICP, is a condition that affects the liver during pregnancy. Usually, bile is produced in the liver and travels to the gut to help food digestion. However, in someone with ICP, the bile acids build up in the body and reach a level of 19 micromol/L or more.
How is obstetric cholestasis diagnosed?
The main symptom of ICP is itching on skin that looks normal and does not have a rash. It usually happens in the third trimester (28 weeks onwards) but can happen before. This can be anywhere on the body and vary in intensity; how itchy you are does not necessarily mean higher levels of bile acid. It is important to contact your maternity unit within 24 hours if you have itching so this can be investigated. Other symptoms include dark wee, yellowing of the skin and pale poo.
If ICP is suspected, other possible causes of the itching must be ruled out first. Your doctor should check to see if a skin condition such as eczema is causing the itching (although these can happen at the same time), and do some blood tests to check your liver is working properly. These tests should be repeated if your itching continues but you have normal blood results, and there doesn’t seem to be any other cause for the itch.
How might ICP affect my pregnancy and baby?
If you have ICP, this may impact your sleep and anxiety levels due to the itching. You also may have a higher chance of developing pre-eclampsia or gestational diabetes, and you should be monitored for this.
As well as the impact of ICP on you personally, there are also risks for your baby. You are more likely to give birth early, before 37 weeks. This can happen naturally, or you may be offered a planned birth, either by induction or c-section, depending on the level of bile acids in your blood.
There is also an increased risk (3%) that your baby will be stillborn, however this risk is only increased if you have severe ICP (bile acid concentration of >100 micromol/L). It is important to monitor your baby’s movements and get checked if they start moving less.
If you suffer from moderate (bile acid concentration of 40-99 micromol/L) or severe ICP, it is more likely that your baby will poo before they are born, which can make them unwell. They are also more likely to need neonatal care after they are born.
You will likely need to give birth in a hospital under the care of a doctor or be asked to have a planned early birth to reduce these risks.
Treatment
There is no treatment for ICP other than giving birth, as there is no way to reduce your bile acid levels. Therefore, it is important that you are monitored closely. You will likely be under the care of an obstetrician and have regular bile acid and liver function tests. The frequency of these will be determined on an individual basis. You may also be prescribed Vitamin K.
Your ICP symptoms will likely improve after you have given birth, however it does increase the risk of having ICP again in future pregnancies. You should ideally have liver function tests following birth to ensure that you do not have any other issues, such as non-alcoholic fatty liver.
There are some things you can do at home to help the itching, such as using an aqueous cream that is safe during pregnancy, or wearing loose, cool clothing.
How can Enable Law help you?
We have acted for mums who did not receive the right care during their pregnancy, which has caused their babies to sadly pass away.
A medical negligence claim is an opportunity for parents and their families to make sure the same mistakes aren’t made again. If you have any worries or concerns about whether your baby’s death occurred because something went wrong with your care, Enable Law’s specialist baby loss team can work with you to help you get the answers you need.
We recognise the devastating impact that losing a baby has. We will work with you to determine what happened, whether the care provided was appropriate and are committed to helping you get the answers you need.
Our specialist baby loss team is here to help
Enable Law has a specialist baby loss team where we have helped many families who have suffered a stillbirth or neonatal death where the monitoring was insufficient or was not interpreted correctly. If you are concerned that you were monitored incorrectly during your pregnancy or labour, and your baby has suffered an injury or passed away, we can advise you. To speak to Nicola Rawlinson-Weller or another member of our team contact us on 0800 044 8488 or fill in our contact form so we can arrange to call you at a time convenient to you.
*not her real name.
This article has been written based on the Royal College of Obstetricians and Gynaecologists guidelines, published 9 August 2022
