Intrahepatic Cholestasis of Pregnancy (ICP) may be a liver disorder which occurs during pregnancy. This condition affects the normal flow of bile. Bile acids are chemicals within the bile of the liver that help with digestion. With ICP the bile flow begins to hamper in tern the bile acids build up within the blood. These results in the woman itching that can vary in severity and type. The itching can be bothersome to severe itching and is often worse at night. There is rarely jaundice when experiencing this condition. Although it has been reported as early as a few 8 weeks pregnant, it is more common for it to begin in the third trimester, when hormone concentrations are at their highest levels. The figure for the share of girls for whom Intrahepatic Cholestasis of Pregnancy will recur in future pregnancies is 60% or as high as 90% for severe ICP.
Who is at risk for ICP?
Overall, 1 to 2 pregnancies in 1000 is suffering from ICP within the USA with Latina populations at 5.6%. Women carrying multiples, women who have had IVF treatment also appear to possess a better risk and people who have had previous liver damage or issues could also be more likely to develop. The incidence of ICP also shows a striking geographical pattern, with a better prevalence in Scandinavia and South America specifically Chile where the reported prevalence is as high as 15.6%. Mothers and sisters of patients also are at higher risk of developing the condition, proving that there's a particular genetic predisposition.
Compromised condition of the fetus, usually discovered during labor, characterized by a markedly abnormal rate or rhythm of myocardial contraction. Some patterns, like decreased movements, meconium passage, high or low pulse , late decelerations of the fetal pulse seen on records of electronic fetal monitoring, are indicative of fetal distress.
Meconium is generally stored within the infant’s intestines until after birth; it's the baby’s first feces which is sticky, thick, and dark green. Sometimes (often in response to fetal distress) it's expelled into the amnionic fluid before birth, or during labor. If the baby then inhales the contaminated fluid, respiratory problems may occur.
Cholestasis patients have a reduced ability to soak up fat-soluble vitamins (A,D and K). This may lead to Vitamin K deficiency. There is a risk of maternal intra- or postpartum hemorrhage. Therefore doctors prescribe oral Vitamin K. There are reports of maternal hemorrhage also as stillbirth in utero and postpartum thanks to ICP induced vitamin K Deficiency.
ICP has been associated with a substantial rate of preterm birth. There is an increased risk of spontaneous preterm labor, which has been seen in as many as 60% of deliveries in some studies, however without active management most studies report rates of 30%-40%. Earlier presentations of Intrahepatic Cholestasis of Pregnancy (ICP) seem to hold a good greater risk of preterm labor, also as twin or triplet pregnancies. Also, there are some data to suggest that neonatal respiratory distress (RDS) following ICP could also be a consequence of the disease process.
What are the symptoms?
Symptoms can vary in severity and type, but the most common ones include:
· Itching all over, but often more severe on palms and soles of the feet. The itching can be recurrent or constant. Many women find that it's worse in the dark and it disturbs their sleep.
· Dark Urine and/or Pale Stools (grayish in color)
· Preterm Labor
Other symptoms may include:
· Right Upper Quadrant Pain
· Fatigue or Exhaustion
· Loss of Appetite
· Mild Depression
What causes ICP?
There is still much to be learned about the precise causes of ICP and its manifestation, but researchers are currently investigating genetic, hormonal and environmental factors. The causes are likely to be due to a number of different factors, including:
Genetic predisposition – Research thus far has identified several gene mutations involved.
ICP has been shown to extend in families. Mothers and sisters are at higher risk of developing the condition, proving that there is a definite genetic predisposition although additional research is needed to explain all cases of the condition in reference to genes.
Pregnancy hormones estrogen and progesterone have an impact on the livers ability to move certain chemicals, including bile acids. The flow of steroid s is significantly reduced and results in the bile acid build up within the blood that causes the symptoms. Note: Women carrying multiples, women who have had IVF treatment also appear to possess a better risk and people who have had previous liver damage or issues could also be more likely to develop.
There are more women diagnosed with Intrahepatic Cholestasis of Pregnancy (ICP) during the winter months. Although the reason for this is not clear, it suggests that there is an environmental trigger for the condition, such as a reduced exposure to sunlight or a change in diet.
What is the treatment for ICP?
Despite the possible outcomes of ICP, proper treatment provides an excellent degree of reduction in both fetal risk and maternal symptoms. With active management that include the 2 most vital factors within the treatment are reducing the bile acids within the bloodstream with the drugs Ursodeoxycholic Acid and delivering the mother as early as lung maturity will allow, often by 37 weeks gestation. In cases where bile acids do not respond to treatment, it may be necessary to deliver earlier than lung maturity to protect the child from the possibility of stillbirth. Unfortunately there is no cure for ICP, and most treatments are aimed at relieving the itch.
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