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Obstetric Cholestasis
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Not every pregnancy goes as predicted and side effects can happen. It is up to the obstetrician, midwife or family practitioner to detect problems that might arise during or immediately after a pregnancy. Obstetric cholestasis is one of the complications of pregnancy that must be looked for when certain symptoms arise. Obstetric cholestasis is also called intrahepatic cholestasis of pregnancy or ICP. It was a condition that, until recently, doctors didn't understand very much about. Women who had it were diagnosed with something else or were ignored due to lack of understanding about what was happening.
It is now known that about seven out of every 1000 pregnancies are complicated by intrahepatic cholestasis. Many doctors believe that more women than this suffer from the disorder but aren't diagnosed correctly. ICP is a liver condition related to pregnancy. The flow of bile to the duodenum is interrupted and bile acids back up into the blood stream from the liver. It leads to poor digestion and poor fat absorption in the digestive system as well as extreme itching from the presence of bile acids under the skin. If the case becomes severe, it can lead to jaundice (yellowing of the eyes and skin). ICP usually begins during the third trimester of pregnancy when the pregnancy hormones are at their peak. In rare cases, it can start in the first trimester of pregnancy.
No one knows exactly why intrahepatic cholestasis of pregnancy occurs. It seems to have some genetic basis and half of all women who get the disease report liver problems occurring in other family members.
The major symptom of ICP is a severe itching condition. It progressively gets worse to the point where the activities of daily living are interrupted including bathing, working, being comfortable at home and sleeping. The itching is most common on the soles of the feet and on the palms of the hands, although any body part can be affected by this disease. Around twenty percent of women develop yellowing of the body and eyes, known as jaundice. Other common symptoms are fatigue, dark urine, loss of appetite, pale stools, and mild depression. Less commonly, you will see severe depression, nausea or pain in the area of the liver (the right upper quadrant). Risks of obstetric cholestasis include prematurity. Around 44 percent of women with ICP will deliver before 37 weeks gestation. There can be hemorrhaging, stillbirth or other evidence of fetal distress.
An early diagnosis is important in ICP because it can help increase surveillance of the pregnancy and can avoid the more serious complications of having the condition. The easiest way to diagnose the condition is to pay attention to the amount of itching a woman has in pregnancy. There are blood tests that can be done from there. These include the serum bile acid test, which measures the level of bile acids in the blood. Not many labs do this test so it may take awhile to get a result back. If a woman is greater than 34 weeks gestation, she should be treated before waiting for the test to come back if she has all the symptoms. Liver function tests can also be done but they may be normal, even in the face of significant ICP. Elevated liver enzymes usually mean the condition is severe.
There are treatment measures that can be used to take care of ICP before it causes problems. The primary form of treatment is called Actigall-a medication used for people with gallstones. It reduces the risk of stillbirth and makes the symptoms better. Vitamin K therapy helps bring up vitamin K in the system. Vitamin K is absorbed poorly whenever the bile acids are not functioning. Corticosteroids help women who are at risk for preterm birth. Corticosteroids help mature the lungs of preterm babies so if they are born early, their lungs are healthier. Corticosteroids also reduce the degree of itching a woman experiences with ICP.