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Obstetric cholestasis otherwise known as 'intrahepatic cholestasis of pregnancy' (ICP) cholestasis is rare and affects about one-in-a-thousand pregnancies in the United Kingdom. It is a disorder of the liver that can cause pain and fatigue accompanied by extreme itchiness to certain parts of the body with an associated risk of injury to the unborn child. If the mother is left untreated there is a grave risk of stillbirth which may possibly be prevented by an early delivery. Failure to diagnose and treat obstetric cholestasis which causes injury to the child or the mother may be grounds for an obstetric cholestasis solicitor to start legal proceedings for medical negligence compensation in a court of law The condition can pose a serious threat to the unborn child if it is not recognised and subsequently treated at an early stage. If you have suffered from this condition it is advisable to contact an obstetric cholestasis solicitor to discuss your options..

It is believed that the high oestrogen levels in pregnancy slow down the flow of bile creating a build-up of bile salts which can cause severe itching and may subsequently cause jaundice. The condition may lead to fatigue, nausea, urinary tract infections, jaundice and there is a 20 per cent risk of post-partum haemorrhage if left untreated. Due to potential danger to the unborn child a baby may have to be induced early if the situation worsens near to the anticipated delivery time.

Although obstetric cholestasis is fairly rare, doctors and nurses should be able to recognise the warning signs, especially when a patient is itching a lot more than normal during pregnancy. Although itching occurs naturally during pregnancy, if there is any sign of jaundice or the itching becomes unbearable, the doctor should carry out a blood test to confirm whether or not obstetric cholestasis is present.

Liver Function Tests Essential

Many doctors and nurses may not be aware that obstetric cholestasis is present because minor itching can be normal during pregnancy. If there is any sign of unwarranted itchiness there is a necessity for the healthcare practitioner to arrange blood tests to establish the condition of the liver. Failure to order liver function tests may in itself be evidence of medical negligence particularly if the mother has made vociferous complaint of being itchy.

Jaundice & Intrahepatic Cholestasis of Pregnancy

Mild jaundice which has distinct symptoms may also accompany intrahepatic cholestasis of pregnancy meaning that a more obvious signal is present. The main symptoms of obstetric cholestasis are extreme itching of the head, face and feet, physical fatigue through loss of sleep, vomiting and occasional mild jaundice. Many of these factors are also associated with a normal pregnancy which is why obstetric cholestasis is often missed.

Obstetric Cholestasis Information

Not every pregnancy goes as predicted and side effects can happen. It is up to the obstetrician, midwife or family practitioner to detect problems that might arise during or immediately after a pregnancy. Obstetric cholestasis is one of the complications of pregnancy that must be looked for when certain symptoms arise. Obstetric cholestasis is also called intra-hepatic cholestasis of pregnancy or ICP. It was a condition that, until recently, doctors didn't understand very much about. Women who had it were diagnosed with something else or were ignored due to lack of understanding about what was happening.

It is now known that about seven out of every 1000 pregnancies are complicated by intra-hepatic cholestasis. Many doctors believe that more women than this suffer from the disorder but aren't diagnosed correctly. ICP is a liver condition related to pregnancy. The flow of bile to the duodenum is interrupted and bile acids back up into the blood stream from the liver. It leads to poor digestion and poor fat absorption in the digestive system as well as extreme itching from the presence of bile acids under the skin. If the case becomes severe, it can lead to jaundice (yellowing of the eyes and skin). ICP usually begins during the third trimester of pregnancy when the pregnancy hormones are at their peak. In rare cases, it can start in the first trimester of pregnancy.

No one knows exactly why intra-hepatic cholestasis of pregnancy occurs. It seems to have some genetic basis and half of all women who get the disease report liver problems occurring in other family members.

The major symptom of ICP is a severe itching condition. It progressively gets worse to the point where the activities of daily living are interrupted including bathing, working, being comfortable at home and sleeping. The itching is most common on the soles of the feet and on the palms of the hands, although any body part can be affected by this disease. Around twenty percent of women develop yellowing of the body and eyes, known as jaundice. Other common symptoms are fatigue, dark urine, loss of appetite, pale stools, and mild depression. Less commonly, you will see severe depression, nausea or pain in the area of the liver (the right upper quadrant). Risks of obstetric cholestasis include prematurity. Around 44 percent of women with ICP will deliver before 37 weeks gestation. There can be haemorrhaging, stillbirth or other evidence of foetal distress.

An early diagnosis is important in ICP because it can help increase surveillance of the pregnancy and can avoid the more serious complications of having the condition. The easiest way to diagnose the condition is to pay attention to the amount of itching a woman has in pregnancy. There are blood tests that can be done from there. These include the serum bile acid test, which measures the level of bile acids in the blood. Not many labs do this test so it may take awhile to get a result back. If a woman is greater than 34 weeks gestation, she should be treated before waiting for the test to come back if she has all the symptoms. Liver function tests can also be done but they may be normal, even in the face of significant ICP. Elevated liver enzymes usually mean the condition is severe.

There are treatment measures that can be used to take care of ICP before it causes problems. The primary form of treatment is called Actigall-a medication used for people with gallstones. It reduces the risk of stillbirth and makes the symptoms better. Vitamin K therapy helps bring up vitamin K in the system. Vitamin K is absorbed poorly whenever the bile acids are not functioning. Corticosteroids help women who are at risk for pre-term birth. Corticosteroids help mature the lungs of pre-term babies so if they are born early, their lungs are healthier. Corticosteroids also reduce the degree of itching a woman experiences with ICP.



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The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here