Intrahepatic Cholestasis of Pregnancy (OC): Frequently asked questions
Intrahepatic Cholestasis of Pregnancy (OC): Frequently asked questions
How is the diagnosis made?
If you have itching without a rash in your pregnancy, then you will have blood tests including a liver function and bile acid level. Raised bile acids will confirm the diagnosis of Intrahepatic Cholestasis of Pregnancy (ICP) which is also known as Obstetric Cholestasis (OC).
What does this mean?
For me
You may have severe itching, often starting on the hands and feet but can affect anywhere on your body. Your doctor can give you medication to calm the itching sensation but it will not disappear until you have given birth.
For my baby
If the bile acids are very high (greater than 100) then there is an increased risk of the baby passing away whilst in the womb, so it is really important that the level of bile acids are monitored every week once the diagnosis is made or as long as you have itching.
What will the medical team recommend?
Your medical team will recommend weekly blood tests at least weekly whilst you have symptoms of itching, and once you have a diagnosis of ICP.
What tests will/may be considered? How often may they be needed?
Blood tests for your liver function and the concentration of bile acids in your blood will be checked regularly.
What symptoms and signs should I be looking out for?
Itching in pregnancy without a rash, particularly if it occurs on the palms of your hands or the soles of your feet.
What are the ‘red flag’ symptoms/concerns, which means that they should be reported immediately?
If your baby isn’t moving like normal, then you should be seen at the hospital immediately.
Likely recomendations
Treatment options
If your bile acids are more than 40 mmol/L, then your doctor may recommend treatment with ursodeoxycholic acid or, in severe cases, other medication such as rifampicin. Your itching can be treated with antihistamine tablets and menthol skin creams. Your medical team will provide a prescription if these medications are recommended to you.
Timing of birth
This will depend on the level of your bile acids but would normally be after 38 weeks if the bile acids are less than 100 mmol/L, and around 36 weeks if your Bile Acids are 100 mmol/L or higher.
How may this affect my birth choices?
Continuous monitoring of your baby’s heartbeat in labour will be recommended whether you labour starts naturally or you are are induced, this is because ICP can affect your baby’s heart function.
How may this affect care after the birth?
If you have had abnormal liver function, you will need to see your GP to retest your liver function levels to ensure they have returned to normal.Your baby will be reviewed by a baby doctor after birth to ensure all is well.
What will this mean for future pregnancies? How can I reduce my risk of this happening again?
There is around 50% chance of having ICP in a subsequent pregnancy so you will be asked to keep a close eye out for symptoms of itching and your doctor may arrange some extra blood tests as part of your monitoring in pregnancy.
What will this mean for future/my long-term health and how can I influence this?
ICP does not cause long term health problems but caution is recommended before taking the combined oral contraceptive pill.There is a strong genetic link so you may want to warn your sisters and daughters as they may also be at risk of having this condition in pregnancy.
