Intrahepatic cholestasis of pregnancy (ICP or obstetric cholestasis) may be mild and harmless but in severe cases may cause damage to the fetus. This is the reason why it needs to be treated appropriately and adequately.
The most important part of management of ICP includes regular monitoring of the pregnant woman for increasing bile acids in blood that could harm the baby.
General management of intrahepatic hepatic cholestasis of pregnancy includes regular liver function tests, fetal monitoring and so forth. 1-7
Regular liver function tests
Pregnant women with suspected ICP need to visit their doctors (antenatal visits) in every one or two weeks to monitor the progress of their pregnancy.
Liver function tests should be monitored weekly. If they return to normal or rise excessively, the diagnosis needs to be revised.
Fetal monitoring
The baby is regularly monitored by ultrasound scans for growth and also for development of complications. Cardiotocography is used to monitor the fetal heart health.
Creams and soothing lotions
Creams and soothing lotions are prescribed for the mother to control the itching. These are safe for both mother and baby but their efficacy is not clearly evidenced.
General lifestyle changes
General measures such as a low fat diet, cool showers, loose cotton clothing, increased water intake are advised.
Anti-itching medications
Some women may be prescribed anti-itching medications called anti-histaminic medications like Chlorpheniramine. These relieve itching and also allow sleeping as they have sedative effects.
Medication therapy for intrahepatic cholestasis of pregnancy (ICP)
Medication therapy includes a drug called Ursodeoxycholic acid (USDA). This can reduce itchiness, improve the function of the liver and reduce the risks to the baby. It leads to side effects like diarrhea.
Cholestyramine has been proven to reduce itching in some women but may lead to further vitamin K deficiency
Vitamin K supplementation
All mothers and babies need to be supplemented with Vitamin K. Mothers need it if they develop jaundice and pale chalky white stools and a deranged blood coagulation profile (increased prothrombin time).
Other fat soluble vitamins like Vitamin D, E and A may also be supplemented as there may be deficiency of these as well.
Timing of delivery
Timing of delivery may have to be carefully decided. The timing aims to reduce the risk of stillbirths. This is done by monitoring the baby closely and look for signs of distress and changes in the heart functions and lung maturity.
In these cases the delivery or labor may be induced or sped up. Chances of maternal or fetal deaths are common after 37 weeks of pregnancy. Labor should be induced beyond this time.
Some women in whom labor cannot be induced a caesarean section is considered.
After birth of the baby
After birth of the baby the LFT usually returns to normal. If it does not, then other diagnosis must be suspected and excluded.
This could include viral liver disease, liver cirrhosis, fatty liver etc. LFTs are checked at six weeks. If, after six months, there is no improvement patient should be evaluated.
All women need to be counselled that there is a 60 to 90% risk of recurrence of the condition in subsequent pregnancies.
Oral contraceptive pills and intrahepatic cholestasis of pregnancy (ICP)
Women with obstetric cholestasis cannot take oral contraceptive pills for contraception after the birth of their babies. These pills often cause liver damage in such women.
This is seen in women with disturbances in LFTs and these pills are generally safe in women who have complete return of normal LFT after childbirth.
Each case has to be decided on an individual basis, based on risks and benefits. Alternative methods of contraception are discussed.
Intrahepatic cholestasis of pregnancy (ICP) and alcohol consumption
Obstetric cholestasis is usually not worsened by alcohol intake. However, pregnant women should avoid drinking alcohol to prevent harm to their baby.
If at all they drink the amount should be limited to no more than one or two units of alcohol one or twice a week.
Further Reading