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Intrahepatic Cholestasis of Pregnancy
Intrahepatic Cholestasis of Pregnancy (ICP), also known as cholestasis in pregnancy, is a condition in which the flow of bile from the liver is temporarily reduced. This causes bile acids to build up in the blood. The main symptom is intense itching, especially on the hands and feet, without any visible rash. The condition is not dangerous for the mother but can pose risks for the baby.
What is intrahepatic cholestasis of pregnancy?
During pregnancy, your body produces extra hormones such as estrogen and progesterone. These hormones can slow down the flow of bile from the liver. When bile does not flow properly, bile acids accumulate in the blood — this is called cholestasis.
Cholestasis of pregnancy usually occurs in the third trimester and typically disappears on its own within a few days to weeks after birth.
What are the symptoms?
The most common symptom is itching without a rash. The itching is often worst on the palms of your hands and the soles of your feet, but it can occur all over the body. Other possible symptoms include:
- Tiredness or difficulty sleeping due to itching;
- Dark urine or pale-colored stools;
- Jaundice (yellowing of the skin and eyes) – this is rare.
How is the diagnosis made?
If you experience severe itching, especially without any visible rash, contact us. We will arrange for blood tests to check your liver function and the level of bile acids in your blood. If these levels are elevated, the diagnosis of intrahepatic cholestasis of pregnancy is confirmed.
What does this mean for your baby?
For you as the mother, cholestasis is unpleasant but usually not dangerous. For your baby, however, there can be some risks, especially if your bile acid levels are very high.
When bile acids build up, the baby may feel less well in the womb. This increases the risk of:
- Premature rupture of membranes or preterm birth;
- Labor starting spontaneously before your due date;
- Rarely: stillbirth (with very high bile acid levels).
For that reason, you will be referred to the hospital (secondary care), where the gynaecologist will take over your care.
Treatment and monitoring
Treatment in the hospital focuses on relieving symptoms and ensuring a safe timing of birth.
- Medication: Your gynaecologist may prescribe medication to lower the bile acid levels in your blood and reduce itching.
- Monitoring: Your bile acids and liver function will be checked regularly for the remainder of your pregnancy. Your baby will also be monitored closely with ultrasound scans and heart rate recordings (CTG).
- Delivery: Depending on the severity of the cholestasis and your gestational age, your gynaecologist may recommend inducing labor, usually between 37 and 38 weeks of pregnancy.
After birth
The itching usually disappears within a few days after delivery. Your liver function and bile acids will be checked once more after birth to ensure everything has returned to normal.
In a future pregnancy, the symptoms may return. If you’ve had cholestasis before, we will monitor you more closely next time.
When to contact us
Always contact us if you experience:
- Sudden or severe itching without a rash;
- Dark urine or pale stools;
- Yellowing of your skin or eyes;
- Reduced fetal movements;
- Any concerns or worry about your baby.