Are any special tests needed, or can a regular obgyn doctor see me for my intrahepatic cholestasis of pregnancy?
Cholestasis of preg. See your OB and he will get help if he needs a specialist.
Fetal monitoring. These pregnancies need to be followed closely since cholestasis of pregnancy is associated with fetal compromise including stillbirth. Serial liver tests & bile acids are checked; non-stress test are recommended 2x/week, and treatment (actigall (ursodiol) 300mg 2x/day) often is beneficial. An OB should be able to manage your care, some refer to mfm. Either should deliver you by 37 weeks if all else is well.
Cholestasis. You could elevated bilirrubin and alkaline phosphatase predominantly. Others sucn as transaminases can be elevated too. They will all normalize upon delivery.
LFTs, bile acids. Liver function tests (alt/ast/alkaline phosphatase) and bile acids can clinch the clinical diagnosis of intrahepatic cholestasis of pregnancy - in the absence of cholelithiasis.
Delivery. It usually goes away at or shortly after delivery.
Yes. There may be some familial predisposition to this disorder as it seems to apear in clusters of related women. It is also more common with multiple pregnancies (twins/triplets) and recurrence risk is as high as 50% or more in subsequent pregnancies. Resolution of symptoms is usually very prompt after delivery.
Until pregnancy ends. Cholestasis of pregnancy is a considition which generally occurs in the 3rd trimester and is characterized by intense pruritis without rash and increase serum levels of free bile acids. The condition lasts until the pregnancy ends. The pruritis sometimes can be controlled with medications, such as ursodiol.
See your doc. The one we know it works in relieving the symptoms if itching is the ursodeoxycolic acid. But in pregnancy this is a very serious condition that requires frequent fetal monitoring, maternal monitoring and potentially delivery before your due date. Please see and ob/gyn specialized in high risk pregnancy if you dont have one.
Uncertain. Cause and treatment of intra-hepatic cholestasis are uncertain. Since it is often associated with itching, you need to protect your skin with emollients and refrain from scratching your skin.
Icp causes itching. I have only had one patient with icp in 27 years of practicing obstetrics. Diagnosis is made by elevated bile salts (detectable by lab test) and the treatment is cholestyramine. Pregnancy outcome should be unaffected by the condition. So icp is rare and makes you miserable, but should not affect your baby. One case however hardly makes me an expert so second opinions welcome.
NO. Cholestasis of pregnancy does not generally cause pain. The most common symptoms is pruritis (itching). It almost always starts with itching on the palms of the hands and soles of the feet, and it is first noticed at night. The itching spreads to other parts of the body over time. Treatment with ursodiol (bile salts) can improve symptoms. Consultation with a high risk OB is recommended.