Obstetric Cholestasis(OC)/Intrahepatic cholestasis of pregnancy (ICP)

What is the liver?

The liver is by far the largest organ in the body, it is situated in the upper  abdomen and is protected from injury by the rib cage. The liver has many important functions.

What is Obstetric Cholestasis?

Obstetric Cholestasis (OC), or intrahepatic cholestasis of pregnancy (ICP) is a complication of pregnancy that affects the liver. Most places and doctors seem to say it is uncommon but I had OC during my first pregnancy and the amount of women who also had OC in the same ward I was in surprised me, so I feel it is probably not as uncommon as it once was.

OC appears to be caused by an over sensitivity to pregnancy hormones.  Bile is produced in the liver and normally it flows down the bile ducts into the intestines where it helps digest foods. If you have OC the flow of bile into the intestines is reduced and so bile salts build up in your blood.

What causes Obstetric Cholestasis?

It is unknown what causes OC and more research is being carried out to try to find out the causes. It is thought to be an hereditary condition so if your mother or sisters were affected then you may find you will suffer to. You may also be more at risk with OC if you are carrying multiples or have had previous liver damage. There also appears to be a strong geographical link with a higher prevalence in Scandinavia and South America. However, some doctors are worried that lower rates in other countries could be down to poor diagnosis and with many cases going undetected.

I am going to be helping with research into this condition at Hammersmith hospital in London, if you would like more information or would like to help also please visit the following website, where you will also find an OC Chat room as well as more information: http://www.icpsupport.org

What are the symptoms of Obstetric Cholestasis ?

Although OC has been reported in early pregnancy it is far more common for it to develop in the third trimester (final 3 months of pregnancy). The main symptom of OC is itching, which can be worse at night, as a result insomnia and fatigue can occur. The itching often begins on the palms of the hands and/or the soles of the feet. Some women scratch so much they cause their skin to bleed.

Other symptoms you may develop could include :

• Dark urine or pale stools
• Loss of appetite
• Mild depression
• Jaundice – this is less common.

The itching completely disappears within a couple of weeks of giving birth (my symptoms disappeared almost immediately). If your symptoms persist you should contact your doctor for further help.

What is the risk to my baby?

The risk of having a stillborn baby is 15% greater in women with OC than for other women, though it is not fully understood why this is. The baby may die due to bile acids crossing the placenta or as a result of being suddenly deprived of oxygen, perhaps due to placental problems.

Elevated levels of bile acids have also been proven to increase the incidence of meconium ( babies first poo, made up of bile, mucus, cells from the bowel wall, and amniotic fluid) being passed whilst still inside and therefore increasing the risk of sudden stillbirth.

Scans will be carried out to check the babies lungs are mature enough for delivery and to survive outside the womb. At present most women with OC will be induced at 35-38 weeks. In cases where bile acids do not respond to treatment then it may be necessary to deliver the baby earlier than lung maturity to protect the child from the risk of stillbirth.

How is Obstetric Cholestasis diagnosed?

If you tell your doctor or midwife about the itching then they will usually consider OC. It is important to remember not all itching will be caused by OC, as the skin stretches some women can experience itchy skin. For OC to be confirmed a liver function test and a bile acid test should be carried out. A bile acid test is not routinely available in most hospitals at present and will usually be sent away to a specialised hospital, because of this results will often take a week to 10 days to return. The bile acid test is the most specific test for OC but due to the length of time it takes to receive the results doctors will usually begin treatment before the results are confirmed.

If you have OC it is important to have a blood test to check how your blood is clotting before the birth as you may need extra vitamin K.

You may also be given an ultrasound to check on the liver and to rule out other liver conditions.

Your pregnancy may involve having regular tests to monitor your baby’s heartbeat , ultrasound scans and blood tests.  Some women have to stay in hospital to make sure that the baby is progressing well. I had to stay in hospital on and off for 2 weeks, then after that had to return every day to have the baby monitored.

How is Obstetric Cholestasis treated?

There are drugs currently used to manage OC, which appear to eliminate or reduce itching and can result in the liver function and bile acid results returning to normal. Steroids may also be considered to help improve the babies lungs maturity.

As mentioned earlier you may need to take vitamin K by mouth until delivery to help the blood clot.

To help with the itching you can try calamine lotion, creams containing calendula, wear loose clothes and avoid hot, humid conditions.

What happens after the birth?

Your baby will be given a vitamin K injection shortly after birth to protect them from bleeding.

OC doesn’t cause any long term damage to the liver however, you should have a follow up liver test 6-12 weeks after delivery to ensure all your levels have returned to normal. You may also be advised to avoid taking any contraception that contains the hormone oestrogen.

What about future pregnancies?

Reported recurrence rates really tend to vary some research states there is about 60% chance that future pregnancies will also be affected by OC, however others suggest there is a 90% chance of recurrence.

If you would like to email me about OC and my experience then you may do so via our feedback page. I had OC in my one and only pregnancy and have a healthy little girl.