Some pregnant women experience severe itching in their hands and legs especially during the second and third trimester. This may be the result of pregnancy specific condition called intrahepatic cholestasis of pregnancy (ICP). Also known by other names such as obstetric cholestasis or cholestasis of pregnancy, ICP is considered to be a benign condition for mother except for the discomforting itching. However, for the fetus ICP can lead to serious consequences such as fetal distress, premature deliver and even fetal death.
The meaning of cholestasis is obstruction of bile flow. Bile is digestive juice secreted by liver and stored in gallbladder.Pregnancy is one of the causes of cholestasis. The exact pathogenesis of intrahepatic cholestasis of pregnancy is unknown, but it is believed to develop due to genetic hypersensitivity to pregnancy hormone estrogen. ICP disappears spontaneously after delivery.
Treatment is aimed at reducing itching and other symptoms in mother and at the same time provide adequate obstetric facility to prevent fetal death.
Causes Of Intrahepatic Cholestasis Of Pregnancy
Despite intense research the exact cause of intrahepatic cholestasis of pregnancy remains unclear. The underlying pathogenesis of ICP is rise of bilirubin in the blood. Liver produces bilirubin when the old red blood cells are destroyed in it.Bilirubin normally mixes with bile juice secreted by liver. Bile helps in digestion of fat.
Researchers believe two factors tend to exist in pathogenesis of intrahepatic cholestasis of pregnancy. A woman may be genetically predisposed to develop ICP as the condition is seen to be running in families. Secondly estrogen hormone is suggested to play a role. During pregnancy hormone estrogen is increased.
Raised level of estrogen may affect the way liver functions. It may slow down the flow of bile in some woman. As a result bile begins to accumulate in the liver and eventually bile acid enters in the bloodstream. Bilirubin in excess causes itching as it gets deposited in various tissues. Too much of bile can harm the fetus. It can pass from mother’s blood to the fetus. Excess of bile acids can cause fetal distress or stillbirths.
Symptoms Of Intrahepatic Cholestasis Of Pregnancy
Severe itching is one of the hallmark symptoms of intrahepatic cholestasis of pregnancy. Itching is especially in late pregnancy, usually begins in third trimester of pregnancy. Another important feature is that itching spontaneously disappears within few days after the delivery.
Most pregnant women having ICP complain of severe itching in palms and sole. However, some women also complain of itching in other parts of body. Itching worsens at night. It does not allow the women to sleep. Other signs and symptoms of intrahepatic cholestasis of pregnancy include loss of appetite, nausea, dark yellow urine, tiredness, mild pain in upper right of abdomen, light colored stool and mild jaundice.
Treatment Of Intrahepatic Cholestasis Of Pregnancy
Treatment of intrahepatic cholestasis of pregnancy is focused on (1) To alleviate the distressing symptom mainly itching in pregnant woman (2) Proper obstetric care. Raised level of bile acids can be harmful to the fetus. It can lead to fetal distress and stillbirth or premature birth. Hence proper obstetric management is of prime importance for a favorable outcome and to reduce complications.
To reduce itching mother is prescribed medicines that will help to reduce bile acids. Application of topical anti histaminic cream or steroid cream will alleviate itching temporarily. Cold compresses on the affected itchy area will relieve the symptoms. Taking oatmeal bath is also beneficial for relieving itching.
Besides, the baby is monitored regularly for any sign of fetal distress. Non stress test is useful in monitoring fetal heart rate and other activity of fetus in the womb.