FAQ - Cholestasis, Intrahepatic
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37 weeks, Intrahepatic Cholestasis of Pregnancy (now in control), What complications my baby can face?


Hi,

Doctor detected Intrahepatic Cholestasis of Pregnancy, on 32 weeks and now it is controlled by medicines. Now no more itching, but i am still on medicine.

I am 37 weeks pregnant and exited to see my babay soon. Please suggest me if i need to consider anything for my baby as i my pregnancy is Intrahepatic Cholestasis of Pregnancy.

Thank you
Regards
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Congrats for the expected baby. In part of my research of all the things that could happen while pregnant, I found this website that could be helpful for you.

http://www.itchymoms.com/  (+ info)

intrahepatic cholestasis? Does having intrahepatic cholestasis mean you have Hep C?


I was exposed to Hep C like 6 yrs ago and tested neg then but with my daughter i had intrahepatic cholestasis, and just now realized it can be tied in with Hep so how serious is it i had her 18 months ago. So does having ICP mean you have Hep?
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No

Here's what I found on about.com

Intrahepatic Cholestasis of Pregnancy - ICP
By Heather Brannon, MD, About.com
Updated: September 25, 2004

Pregnancy Classes

Intrahepatic cholestasis of pregnancy (ICP) is the second most common cause of jaundice in pregnancy. Its prevalence varies from country to country. In the United States, Switzerland, and France ICP occurs in less than 0.5% of pregnancies. However, ICP occurs in 11.8% to 27.6% of pregnancies to women of Araucanian Indian descent in Chile.

Appearance

The most common symptom of intrahepatic cholestasis of pregnancy is itching which typically develops in the third trimester of pregnancy. The itching begins on the palms and soles, and then spreads to the rest of the body. The rash of ICP is caused by scratching the intensely itchy skin. Jaundice occurs in 10% to 15% of cases and typically develops 2 to 4 weeks after the itching starts. After delivery, both itching and jaundice resolve spontaneously. ICP does recur with subsequent pregnancies in 40% to 50% of women.

Cause

Intrahepatic cholestasis of pregnancy is caused by an impairment of bile secretion in the liver. As the bile backs up in the liver, the level of bile acids increases in the bloodstream. These bile acids are deposited in the skin causing the intense itching. Cholesterol, triglyceride, and bilirubin levels are also increased.

Several complicated mechanisms have been proposed to explain this impairment of bile secretion, but it appears that genetic and hormonal factors are involved. Women who have a mother or sister who has had ICP are at a higher risk of developing this condition. Also, estrogen interferes with the clearance of bile from the liver, and progesterone interferes with the clearance of estrogen from the liver.

Related symptoms

Women with intrahepatic cholestasis of pregnancy may also experience anorexia, fatigue, greasy stools, dark urine, and epigastric discomfort. Urinary tract infections are more common in women with ICP than unaffected pregnant women. Finally, a deficiency of vitamin K can develop in women who have a prolonged course of ICP.

Diagnosis

Intrahepatic cholestasis of pregnancy is diagnosed by blood tests showing elevated levels of bile acids and certain liver enzymes. The presence of itching without a primary rash also helps to confirm the diagnosis. A liver biopsy or ultrasound is rarely needed to establish the diagnosis.

Effect on Baby

The liver of a healthy fetus has a limited ability to remove bile acids from the blood. The fetus normally has to rely on the maternal liver to perform this function. Therefore, the elevated levels of maternal bile cause stress on the fetal liver. Intrahepatic cholestasis of pregnancy increases the risk to the baby of meconium staining during delivery, preterm delivery, and intrauterine death. Women with ICP should be monitored closely, and serious consideration should be given to inducing labor as soon as fetal lung maturity is confirmed.

Treatment

The itching of ICP can be treated with emollients, antihistamines, soothing baths, primrose oil, and anti-itching products such as Sarna. Medications that aid in bile secretion such as ursodeoxycholic acid (UDCA), cholestyramine, and S-adenosylmethionine have shown variable benefits in reducing itching and bile levels. High dose oral steroids may also be a possible treatment for ICP.  (+ info)

What it is: Progressive Familial Intrahepatic Cholestasis?


... and what is the best treatment for it?
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From the Cincinnati Children's Hospital website:

"Progressive familial intrahepatic cholestasis (PFIC) is a rare inherited condition in which children are unable to drain bile from the liver even though the large bile ducts are open (called cholestasis).

This usually begins in infants less than six months of age and may get worse very quickly. However, some children initially show signs later, even as late as the teen years, and the condition progresses more slowly. Nearly all children with progressive familial intrahepatic cholestasis will require treatment before age 30.

In many cases, progressive familial intrahepatic cholestasis leads to cirrhosis (irreversible scarring of the liver) and liver failure within the first 10 years of life. A liver transplant may be necessary for survival.

Treatment:

Some patients may respond to medical therapy, although surgical treatment is usually necessary for survival.

Surgical treatment used in children with progressive familial intrahepatic cholestasis includes liver transplantation for cirrhosis and partial external biliary diversion (PEBD).

Liver Transplantation

Liver transplantation may be used if partial external biliary diversion is ineffective or if the patient has liver cirrhosis. It is the only effective treatment of high-GGT PFIC.

Most progressive familial intrahepatic cholestasis disorders progress to end-stage liver disease and require liver transplantation. Treatment focuses on minimizing growth failure and decreasing discomfort as the child awaits liver transplantation. Survival rates for liver transplantation to treat progressive familial intrahepatic cholestasis are excellent.

Partial External Biliary Diversion (PEBD)

Partial external biliary diversion may be used as the first choice of treatment for patients who have not yet developed cirrhosis. This treatment helps reduce the circulation of bile acids in the liver in order to reduce complications and prevent the need for early transplantation in many patients.

This surgical technique involves isolating a segment of intestine 10 cm long for use as a biliary conduit (a channel for the passage of bile) from the rest of the intestine. One end of the conduit is attached to the gallbladder and the other end is brought out to the skin to form a stoma (a surgically constructed opening to permit the passage of waste).

Partial external biliary diversion is used for patients who are unresponsive to all medical therapy, especially older, larger patients. This procedure may not be of help to young patients such as infants. Partial external biliary diversion may decrease the intensity of the itching and abnormally low levels of cholesterol in the blood."  (+ info)

Can someone please tell me about the long term health effects of Intrahepatic Cholestasis of Pregnancy (ICP)?


I had a baby five months ago and I believe that I had undiagnosed (and consequently untreated) ICP at the time, which resulted in a premature delivery (at 35 weeks). My baby is healthy and doing well but my liver function tests have come back with a few highly elevated readings. Does anyone have any experience of this?
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Please see a physician to monitor the condition because the liver is a vital organ that handles all toxic substances which enters the body and can be destroyed too by these substances.  (+ info)

has anyone suffered from intrahepatic cholestasis of pregnancy or ICP?


what happened to you and your child, and how did they find out you had it?
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There is a good resource for ICP moms at www.itchymoms.com.

There are also some active Yahoo Groups where you can get more personalized advice and experiences.  (+ info)

did/does anyone have PUPPP, Pemphigoid gestationis, or Intrahepatic Cholestasis of Pregnancy?


if any one had any of these what were your symptoms? what did it look like? and what kind of tests did your doctor do to confirm it? also what was the treatment? and was there any risk to your baby?
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I had Cholestasis of Pregnancy. I just started itching really badly. Mostly on my palms and my feet, but I did itch other places. My doctor did a few liver enzyme tests and realized that those enzymes were elevated. They delivered my little girl almost a month early due to the possibility of stillbirth and other possible risks. Check out the web site below! Lots of helpful advice!  (+ info)

Repost: Did/does anyone have PUPPP, Pemphigoid gestationis, or Intrahepatic Cholestasis of Pregnancy?


if any one had any of these what were your symptoms? what did it look like? and what kind of tests did your doctor do to confirm it? also what was the treatment? and was there any risk to your baby?

i asked this earlier, im sorry if any of you saw it then but im hoping for a new group of people who didn't see it, more answers. thanks.
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This website should have all the info you need - http://www.itchymoms.com/  (+ info)

intrahepatic cholestasis of pregnancy?


Hi my sister in law is 32 weeks pregnant and was just diagnosed with intrahepatic cholestasis. This is where your liver stops functioning during pregnancy. One of the symptoms is extremem itching all over your body. My sister in law has uncontrollable itching, she can't even sleep at night she says it is horrible! I was reading that one of the risk of ICP is that there is a higher chance of the baby being stillborn.
Now my questions is...if she is being monitored weekly from now on, what are the chances that her baby will be stillborn?? This is freaking me out, she obviously doesn't really know the risks because she seems very nonchalant about this (she is 17) Anyone have any personal stories or know someone that had ICP???
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I just had my daughter in April and I too SUFFERED from ICP. It was awful!! I couldn't sleep at night either! I itched all the time. And I was also worried about my baby being stillborn. But more than likely, they will induce labor when she's 36 or 37 weeks pregnant. I was 36 weeks. They just want to make sure the baby's lungs are fully developed before they induce. Give your sister in law the facts. No matter what her age is she should be worried about the well being of her child. Check out my source. Its a great site and yahoo also has a group for pregnant women who suffer from ICP. I hope everything goes good for her and the baby!!  (+ info)

Anyone had intrahepatic cholestasis of pregnancy or ICP and delivered safely?


I am 25 weeks and may have ICP. I also have elevated blood pressure and +2 proteins in my urine. Anyone have those and deliver at term? How did your baby do? Also... did anyone have preeclampsia diagnosed this early in pregnancy and NOT have problems? If you did have problems what were they?? Thanks in advance for all the answers!
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if you do have this you will need to deliver early,i answered a question of yours a couple of weeks back,i thought that is what you had  (+ info)

Have you heard of Intrahepatic Cholestasis of Pregnancy? I had it w/ my 1st baby and had her at 34 weeks.?


I am @ 30weeks now w/ my 2nd baby and I am starting to itch again. I am trying to decide if I should take a round of steroid shots to help the baby's lung develop faster incase I have to deliver early again. Any opinions?

If you have not heard of or had ICP then you will most likely not understand the purpose of delivering early.. This is a condition in which your liver shuts down and dumps your bile salt into your blood stream. It makes you itch very very badly and the chances of the baby being stillborn sky rocket at 36 weeks. If you have ICP most people say you need to deliver at or before 37 weeks. (FYI)
I am @ 30weeks now w/ my 2nd baby and I am starting to itch again. I am trying to decide if I should take a round of steroid shots to help the baby's lung develop faster incase I have to deliver early again. Any opinions?

If you have not heard of or had ICP then you will most likely not understand the purpose of delivering early.. This is a condition in which your liver shuts down and dumps your bile salt into your blood stream. It makes you itch very very badly and the chances of the baby being stillborn sky rocket at 36 weeks. If you have ICP most people say you need to deliver at or before 37 weeks. (FYI)

I itched EVERYWHERE!!!
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hi I am on baby 4 but my third with ICP. Are you having regular bile salt tests? Have you looked at the chat site for ICP sufferers http://health.groups.yahoo.com/group/itchymoms/messages
it is great, others share there experience with you and they can give you some great medical info. I can't help you with you question about the steroids because more info is needed such as, Is your Dr helpful with ICP(most aren't)? Are they considering induction before 36 weeks(they should be if not)? I think with your history of delivering so early with your firstBABY talking to your Dr about steroids are definitely an option.
Email me if you want to talk.  (+ info)

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