Materiały źródłowe

• #1 Pregnancy Intrahepatic Cholestasis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK551503/

  Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disorder in pregnancy and is associated with an increased risk of adverse obstetrical outcomes like sudden fetal demise. This activity describes the pathophysiology, evaluation, and treatment of ICP, and highlights the role of the interprofessional team in evaluating and managing affected patients. […] The diagnosis of intrahepatic cholestasis of pregnancy (ICP) is via the presence of clinical symptom that is pruritus in the third trimester with elevated maternal total serum bile acids and excluding other diagnoses, which can cause similar symptoms and lab abnormalities. […] Once the diagnosis of intrahepatic cholestasis of pregnancy (ICP) is confirmed, immediate treatment is necessary, and the primary goal of therapy is to decrease the risk of perinatal morbidity and mortality and to alleviate maternal symptoms.

• #2 Intrahepatic cholestasis of pregnancy: MedlinePlus GeneticsLock

  https://medlineplus.gov/genetics/condition/intrahepatic-cholestasis-of-pregnancy/

  Intrahepatic cholestasis of pregnancy is the most common liver disease related to pregnancy. […] Intrahepatic cholestasis of pregnancy is a complex disorder. It is believed to be caused by a combination of genetic, hormonal, and environmental factors. […] An increased susceptibility to intrahepatic cholestasis of pregnancy typically has an autosomal dominant pattern of inheritance, which means one copy of the altered gene in each cell is sufficient to increase the risk of developing the disorder.

• #3 Bile Acids in Intrahepatic Cholestasis of Pregnancy

  https://www.mdpi.com/2075-4418/12/11/2746

  Bile acids in intrahepatic cholestasis of pregnancy (ICP) is the most common, reversible, and closely related to pregnancy condition characterized by elevated levels of bile acids (BAs) in blood serum and an increased risk of adverse perinatal outcomes. […] Although ICP cannot be completely prevented, its early diagnosis and prompt management significantly reduce the risk of fetal complications, the most serious of which is unexpected intrauterine death. […] The disease is usually mild in pregnant women, but it can be fatal to the fetus, leading to numerous complications, including intrauterine death. […] The main purpose of the therapy of ICP is to reduce the severity of clinical symptoms and normalize the biochemical exponents of maternal liver dysfunction and minimize the risk of complications, both fetal and neonatal.

• #4 Cholestasis of pregnancy – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cholestasis-of-pregnancy/symptoms-causes/syc-20363257

  Intrahepatic cholestasis of pregnancy, commonly known as cholestasis of pregnancy, is a liver condition that can occur in late pregnancy. The condition triggers intense itching, but without a rash. Itching is usually on the hands and feet but also can occur on other parts of the body. […] Cholestasis of pregnancy can make you very uncomfortable. But more worrisome are the potential complications, especially for your baby. Because of the risk of complications, your pregnancy care provider may recommend early term delivery around 37 weeks. […] Contact your pregnancy care provider right away if you begin to feel constant or extreme itchiness. […] Because complications can be very dangerous for your baby, your pregnancy care provider may consider inducing labor before your due date.

• #5 Intrahepatic cholestasis of pregnancy | March of Dimes

  https://www.marchofdimes.org/find-support/topics/pregnancy/intrahepatic-cholestasis-pregnancy

  ICP is a liver condition that can increase your risk for problems, including preterm birth, stillbirth and heavy bleeding after birth. […] If you have any signs or symptoms of ICP, like feeling itchy on the palms of your hands or soles of your feet, tell your health care provider. […] Your provider treats ICP with medicine to help your liver work better and relieve itching. Treatment also can help reduce your risk for stillbirth. […] ICP usually goes away a few days after you give birth. […] If you have ICP once, you may have it again in a future pregnancy. […] Signs and symptoms of ICP can range from mild to severe and may begin in your second or third trimester. Call your provider if you have signs and symptoms of ICP, including: Severe itching. Itchy skin is the most common symptom of ICP.

• #6 Cholestasis of Pregnancy: Causes, Symptoms & Treatment

  https://americanpregnancy.org/healthy-pregnancy/pregnancy-complications/cholestasis-of-pregnancy/?sw_cache=rebuild

  Pregnancy hormones affect liver function, resulting in slowing or stopping the flow of bile. The gallbladder holds bile that is produced in the liver, which is necessary for the breakdown of fats in digestion. When the bile flow in the liver itself is stopped or slowed down, this causes a build up of bile acids in the liver which can spill into the bloodstream. ICP is diagnosed when the total bile acids (TBA) or serum bile acids are measured at 10 micromol/L and above. Studies initially showed that this increase in bile acids was due to estrogen only, but recent research has found that progesterone may contribute just as much to this backup. […] What Are the Symptoms of Cholestasis of Pregnancy? […] Itching, particularly on the hands and feet (often is the only symptom noticed) […] Dark urine color […] Pain in the right upper quadrant (RUQ), without gallstones […] Pale/Light coloring of bowel movements […] Fatigue or exhaustion […] Loss of appetite […] Depression […] Less common symptoms include: Jaundice (yellow coloring of skin, eyes, and mucous membranes) […] Upper-Right Quadrant Pain […] Nausea.

• #7 Itching and intrahepatic cholestasis of pregnancy – NHS

  https://www.nhs.uk/pregnancy/related-conditions/complications/itching-and-intrahepatic-cholestasis/

  Itching can be a symptom of a liver condition called intrahepatic cholestasis of pregnancy (ICP), also known as obstetric cholestasis (OC). […] ICP needs medical attention. It affects around 1 in 140 pregnant women in the UK. […] If you have ICP, you will probably be advised to give birth in hospital under a consultant-led maternity team. […] If you are diagnosed with ICP, you will have regular liver blood tests (LFTs) and bile acid measurement tests so your doctor can monitor your condition. […] Creams, such as aqueous cream with menthol, are safe to use in pregnancy and can provide some relief from itching. […] A medicine called ursodeoxycholic acid (UDCA) can be prescribed to try to relieve itching. […] If you are diagnosed with ICP, your midwife and doctor will discuss your health and your options with you.

• #8 Navigating Perinatal Challenges: A Comprehensive Review of Cholestasis of Pregnancy and Its Impact on Maternal and Fetal Health

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11109475/

  Cholestasis of pregnancy (CP), or intrahepatic CP (ICP), represents a condition peculiar to pregnancy, marked by impaired bile acid flow and consequent accumulation in the maternal bloodstream. Primarily emerging in the third trimester, CP is linked with considerable risks to both the mother and fetus, including heightened incidences of preterm birth, fetal distress, and stillbirth, alongside maternal complications such as intense pruritus and liver dysfunction. […] Given its potential severity, a comprehensive understanding of this condition is essential for effective management and improved outcomes. This review aims to provide a comprehensive overview of CP, focusing on its pathophysiology, clinical manifestations, maternal and fetal complications, management strategies, prognosis, and future research directions.

• #9

  https://www.nursingcenter.com/journalarticle?Article_ID=2726130&Journal_ID=54008&Issue_ID=2725945

  Intrahepatic cholestasis of pregnancy is the most common liver disease of pregnancy. It is characterized by pruitus, elevated levels of maternal serum bile salts, and normal or mildly elevated liver enzymes occurring after 30 weeks of pregnancy. The primary risks associated with this condition include preterm delivery, meconium-stained amniotic fluid, and stillbirth. Management of intrahepatic cholestasis of pregnancy utilizes a 2-prong approach of oral medications and comfort measures along with active management close to term. The goal of active management has been to deliver women between 37 and 39 weeks of gestation in order to prevent the risk of stillbirth. Currently, expert opinions vary as to recommendations for fetal surveillance and induction of labor. Controversy exists as to whether there is an increased incidence of stillbirth between 37 and 39 weeks of gestation. […] This critical clinical review is a comprehensive overview of intrahepatic cholestasis of pregnancy, including background, controversies, and care of the pregnant woman with this condition and how to provide appropriate follow-up care later after delivery.

• #10 Pregnancy Intrahepatic Cholestasis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK551503/

  Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disorder in pregnancy and is associated with an increased risk of adverse obstetrical outcomes like sudden fetal demise. This activity describes the pathophysiology, evaluation, and treatment of ICP, and highlights the role of the interprofessional team in evaluating and managing affected patients. […] The diagnosis of intrahepatic cholestasis of pregnancy (ICP) is via the presence of clinical symptom that is pruritus in the third trimester with elevated maternal total serum bile acids and excluding other diagnoses, which can cause similar symptoms and lab abnormalities. […] Once the diagnosis of intrahepatic cholestasis of pregnancy (ICP) is confirmed, immediate treatment is necessary, and the primary goal of therapy is to decrease the risk of perinatal morbidity and mortality and to alleviate maternal symptoms.

• #11 Intrahepatic cholestasis of pregnancy – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/800

  Intrahepatic cholestasis of pregnancy (ICP) is characterised by maternal pruritus (itch) and liver dysfunction, with raised total serum bile acid concentrations, in the absence of other contributing liver disorders and restricted to pregnancy. […] The condition is associated with an increased risk of adverse pregnancy outcomes for the newborn, including spontaneous preterm birth, meconium-stained amniotic fluid, neonatal unit admission, and, if the mothers serum bile acid concentrations are elevated to a level of 100 micromol/L, stillbirth. Maternal complications include an increased risk of gestational diabetes and pre-eclampsia, in addition to impaired glucose tolerance and dyslipidaemia. […] The only definitive cure is delivery of the baby. […] Pregnant women with total serum bile acid concentrations of 40 micromol/L and mild itching can be offered symptomatic treatment, such as topical emollients and sedating antihistamines.

• #12 Cholestasis of Pregnancy: Causes, Symptoms & Treatment

  https://americanpregnancy.org/healthy-pregnancy/pregnancy-complications/cholestasis-of-pregnancy/?sw_cache=rebuild

  Pregnancy hormones affect liver function, resulting in slowing or stopping the flow of bile. The gallbladder holds bile that is produced in the liver, which is necessary for the breakdown of fats in digestion. When the bile flow in the liver itself is stopped or slowed down, this causes a build up of bile acids in the liver which can spill into the bloodstream. ICP is diagnosed when the total bile acids (TBA) or serum bile acids are measured at 10 micromol/L and above. Studies initially showed that this increase in bile acids was due to estrogen only, but recent research has found that progesterone may contribute just as much to this backup. […] What Are the Symptoms of Cholestasis of Pregnancy? […] Itching, particularly on the hands and feet (often is the only symptom noticed) […] Dark urine color […] Pain in the right upper quadrant (RUQ), without gallstones […] Pale/Light coloring of bowel movements […] Fatigue or exhaustion […] Loss of appetite […] Depression […] Less common symptoms include: Jaundice (yellow coloring of skin, eyes, and mucous membranes) […] Upper-Right Quadrant Pain […] Nausea.

• #13 Intrahepatic Cholestasis of Pregnancy: New Insights on an Old Issue – Women’s Healthcare

  https://www.npwomenshealthcare.com/intrahepatic-cholestasis-of-pregnancy-new-insights-on-an-old-issue/

  Intrahepatic cholestasis of pregnancy (ICP) is a hepatic disorder that complicates 0.2% to 2% of pregnancies and poses significant risk to the fetus including preterm delivery and stillbirth. […] Diagnosis is made when total bile acids are greater than 10 mol/L. Ursodeoxycholic acid is first-line treatment. Antepartum surveillance is recommended when delivery would be considered in response to abnormal results. Delivery timing is guided by bile acid levels, patient presentation, and history. […] Newly published literature and updated evidence-based recommendations from the Society for Maternal-Fetal Medicine (SMFM) for the assessment and management of ICP are presented to provide the reader with the most current assessment, diagnostic, treatment, and patient education recommendations. […] Treatment goals include reduction in both maternal pruritis symptoms and adverse perinatal outcomes. Ursodeoxycholic acid (UCDA) is a naturally occurring bile acid that is used to treat hepatobiliary disorders.

• #14 Maternal and fetal outcome in intrahepatic cholestasis of pregnancy at tertiary care institute of North India – Indian Journal of Medical Sciences

  https://ijmsweb.com/maternal-and-fetal-outcome-in-intrahepatic-cholestasis-of-pregnancy-at-tertiary-care-institute-of-north-india/

  Itching over whole body was the predominant presenting complaints of cholestasis of pregnancy. […] Diagnosis should be supported by bile acids in women with normal liver enzymes to decrease the cost of investigations. […] Early termination of pregnancy between 36 and 37 weeks can be considered in women with bile acids 40 mol/L and in non-compliant patients on UDCA treatment. […] There was no correlation found between cholestasis of pregnancy with preterm labor and meconium-stained liquor in the present study. […] All confirmed cases of IHCP were advised to take ursodeoxycholic acid (UDCA) 1015 mg/kg/day, with a maximum dose of 300 mg 8 hourly by oral route. […] Fetal surveillance was done in confirmed cases with weekly biophysical profile till delivery. […] Induction of labor was done in 64.6% versus 18.8% patients in cases and control, respectively.

• #15

  https://www.nursingcenter.com/journalarticle?Article_ID=2726130&Journal_ID=54008&Issue_ID=2725945

  Intrahepatic cholestasis of pregnancy is the most common liver disease of pregnancy. It is characterized by pruitus, elevated levels of maternal serum bile salts, and normal or mildly elevated liver enzymes occurring after 30 weeks of pregnancy. The primary risks associated with this condition include preterm delivery, meconium-stained amniotic fluid, and stillbirth. Management of intrahepatic cholestasis of pregnancy utilizes a 2-prong approach of oral medications and comfort measures along with active management close to term. The goal of active management has been to deliver women between 37 and 39 weeks of gestation in order to prevent the risk of stillbirth. Currently, expert opinions vary as to recommendations for fetal surveillance and induction of labor. Controversy exists as to whether there is an increased incidence of stillbirth between 37 and 39 weeks of gestation. […] This critical clinical review is a comprehensive overview of intrahepatic cholestasis of pregnancy, including background, controversies, and care of the pregnant woman with this condition and how to provide appropriate follow-up care later after delivery.

• #16 cholestasis of pregnancy – Nursing Notebook

  https://nursing-notebook.com/en-ie/simplepage.cfm?ID=134611012&linkID=49171

  Intrahepatic cholestasis of pregnancy (ICP: also known as obstetric cholestasis) is a pregnancy-specific liver condition appearing most often in the third trimester […] is a relatively benign but often very distressing condition for the woman, but it may adversely affect fetal outcome, as seen by associations with preterm labour, fetal distress and stillbirth, particularly in severe cases […] diagnosed when otherwise unexplained pruritus occurs in pregnancy and abnormal liver function tests (LFTs) and/or raised bile acids occur in the pregnant woman and both resolve after delivery. Pruritus that involves the palms and soles of the feet is particularly suggestive […] women with persistent pruritus and normal biochemistry should have LFTs repeated every 12 weeks […] once obstetric cholestasis is diagnosed, it is reasonable to measure LFTs weekly until delivery

• #17 Intrahepatic cholestasis of pregnancy | RCOG

  https://www.rcog.org.uk/for-the-public/browse-our-patient-information/intrahepatic-cholestasis-of-pregnancy/

  ICP is a condition that affects how your liver works when you are pregnant. It is sometimes called obstetric cholestasis. […] Your ICP will be monitored with regular blood tests to check your liver function and the levels of bile acids in your blood. […] Once you have been diagnosed with ICP, you should be under the care of an obstetrician. Your blood tests will usually be repeated after one week and an individualised plan of care will be made for you depending on your circumstances. […] Treatments to improve your itching are of limited benefit but might include: Skin creams such as aqueous cream, with or without the addition of menthol; Antihistamines, which may help you sleep at night; Some women have found that having cool baths and wearing loose-fitting cotton clothing helps to reduce the itching.

• #18 Intrahepatic cholestasis of pregnancy – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/800

  The risk of stillbirth is increased for pregnant women with total serum bile acid concentrations of 100 micromol/L, and so delivery should be offered to these women at 35 to 36 gestational weeks. […] Treatment with ursodeoxycholic acid does not effectively reduce total serum bile acid concentrations or clearly prevent stillbirth. However, it does cause a marginal improvement in maternal itch, decrease alanine aminotransferase concentrations, and reduce the risk of spontaneous preterm birth in women with serum bile acid concentrations of 40 micromol/L.

• #19 Cholestasis of Pregnancy: Causes, Symptoms, & Treatment | Zaya

  https://zayacare.com/blog/cholestasis-of-pregnancy/

  Cholestasis of pregnancy will not generally be harmful to you unless you have low Vitamin K levels and bleeding complications, including postpartum hemorrhage. Similar hemorrhages can occur in the fetal brainoften with dire consequences. […] Because most complications are severe, the doctor will follow the total bile acid levels in the blood. Most complications happen if the level is above 40 millimoles per liter. This is the time when the risks of delivery are less than remaining pregnant.

• #20 Pregnancy Intrahepatic Cholestasis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK551503/

  The management of intrahepatic cholestasis of pregnancy (ICP) must be an interprofessional team approach. Typically, whenever feasible, an interprofessional team should include an obstetrician, maternal-fetal medicine specialist (MFM), gastroenterologist, anesthetist, and the nursing team. […] A weekly biophysical profile for fetal health monitoring should take place in patients with ICP with elevated total bile acid level (over 100 micromol/L). Delivery between 36 to 37 weeks should be considered to avoid fetal complications in a patient with severely elevated total bile salt acid levels and other risk factors, as mentioned above. Once the condition gets diagnosed, the patient should be closely monitored by the nurse and obstetrician to ensure that the ICP is not worsening. A team approach to patient management is vital if one wants to improve outcomes.

• #21 Treatment for Intrahepatic Cholestasis of Pregnancy – ICP Care

  https://icpcare.org/intrahepatic-cholestasis-pregnancy/treatment/

  Treatment for Intrahepatic Cholestasis of Pregnancy involves 3 main parts: monitoring, medication treatment, and early delivery. […] Monitoring involves following bile acid levels and fetal monitoring including non-stress testing (NSTs) […] Medication treatment involves a first-line, albeit off-label, treatment with a medication called ursodeoxycholic acid (Ursodiol or Actigall) […] Early delivery is recommended most often around 36 0/7-39 0/7 weeks with earlier deliveries considered on a case by case basis depending on bile acid levels. […] Fetal monitoring is recommended in a pregnancy complicated by Intrahepatic Cholestasis of Pregnancy. […] A specific timeframe to begin monitoring has not been established but often begins around 32 weeks. Your provider will decide on a plan for fetal monitoring.

• #22 Intrahepatic Cholestasis of Pregnancy Treatment & Management: Medical Care, Prevention

  https://emedicine.medscape.com/article/1562288-treatment

  Antenatal testing, including umbilical artery Doppler studies, biophysical profile (BPP), and nonstress tests, have all been performed to reduce the risk of stillbirth. Patients with intrahepatic cholestasis of pregnancy (ICP) should have regular antenatal testing (starting at 32-34 weeks) with consideration for Doppler flow studies of the umbilical artery. […] Delivery is commonly recommended at 37 weeks without an amniocentesis for fetal lung maturity due to increased risk of fetal mortality, or after an amniocentesis for delivery prior to 37 weeks gestation. If meconium is present at the time of amniocentesis, delivery is indicated regardless of the fetal lung maturity results. Delivery can proceed without an amniocentesis if the fetal monitoring is nonreassuring. Some providers are now waiting until 38-39 weeks gestation to deliver if there is resolution of pruritus symptoms with treatment and bile acid levels are not significantly elevated (less than 40 mol/L).

• #23 Cholestasis of Pregnancy: Causes, Symptoms & Treatment

  https://americanpregnancy.org/healthy-pregnancy/pregnancy-complications/cholestasis-of-pregnancy/?sw_cache=rebuild

  Cholestasis may increase the risks for fetal distress, preterm birth, or stillbirth. A developing baby relies on the mother’s liver to remove bile acids from the blood; therefore, the elevated levels of maternal bile cause stress on the baby’s liver. Women with cholestasis should be monitored closely and serious consideration should be given to inducing labor once the baby’s lungs have reached maturity. […] The treatment goals for cholestasis of pregnancy are to relieve itching. Make sure you speak with your healthcare provider before taking any medications or supplements. Some treatment options include: Topical anti-itch medications or medication with corticosteroids […] Medication to decrease the concentration of bile acids such as ursodeoxycholic acid […] Cold baths and ice water slow down the flow of blood in the body by decreasing the temperature […] Dexamethasone is a steroid that increases the maturity of the baby’s lungs […] Vitamin K supplements administered to the mother before delivery and again once the baby is born to prevent intracranial hemorrhaging […] Dandelion Root and Milk Thistle are natural substances that are beneficial to the liver (talk to your healthcare provider before taking these) […] Bi-weekly non-stress tests which involve fetal heart monitoring and contraction recordings […] Regular blood tests monitoring both bile serum levels and liver function.

• #24 Intrahepatic Cholestasis of Pregnancy Treatment & Management: Medical Care, Prevention

  https://emedicine.medscape.com/article/1562288-treatment

  Antenatal testing, including umbilical artery Doppler studies, biophysical profile (BPP), and nonstress tests, have all been performed to reduce the risk of stillbirth. Patients with intrahepatic cholestasis of pregnancy (ICP) should have regular antenatal testing (starting at 32-34 weeks) with consideration for Doppler flow studies of the umbilical artery. […] Delivery is commonly recommended at 37 weeks without an amniocentesis for fetal lung maturity due to increased risk of fetal mortality, or after an amniocentesis for delivery prior to 37 weeks gestation. If meconium is present at the time of amniocentesis, delivery is indicated regardless of the fetal lung maturity results. Delivery can proceed without an amniocentesis if the fetal monitoring is nonreassuring. Some providers are now waiting until 38-39 weeks gestation to deliver if there is resolution of pruritus symptoms with treatment and bile acid levels are not significantly elevated (less than 40 mol/L).

• #25 Obstetric Cholestasis – Saolta Maternity Services

  https://www.uhgmaternity.com/pregnancy/obstetric-cholestasis/

  Obstetric cholestasis is a disorder that affects your liver during pregnancy. This causes a build up of bile acids (yellow / green fluid which help digest fats) in your body. The main symptom is itching of the skin but there is no skin rash. The symptoms get better when your baby has been born. Obstetric cholestasis is uncommon. In the UK, it affects about 7 in 1000 women (less than 1%). Obstetric cholestasis is more common among women of Indian-Asian or Pakistani-Asian origin, with 15 in 1000 women (1.5%) affected. […] Obstetric cholestasis can be a very uncomfortable condition, but it does not have any serious consequences for your health. […] If you have cholestasis you need to be monitored closely. […] Once diagnosed with obstetric cholestasis, you should be under the care of a consultant and have your baby in a consultant-led maternity unit with a neonatal unit. Depending upon your circumstances, you will be advised to have additional antenatal checks. Additional monitoring of your baby may include monitoring your baby’s heart rate (cardiotocography) and ultrasound scans for growth and measuring the amount of fluid around your baby.

• #26 Intrahepatic Cholestasis of Pregnancy Treatment & Management: Medical Care, Prevention

  https://emedicine.medscape.com/article/1562288-treatment

  Antenatal testing, including umbilical artery Doppler studies, biophysical profile (BPP), and nonstress tests, have all been performed to reduce the risk of stillbirth. Patients with intrahepatic cholestasis of pregnancy (ICP) should have regular antenatal testing (starting at 32-34 weeks) with consideration for Doppler flow studies of the umbilical artery. […] Delivery is commonly recommended at 37 weeks without an amniocentesis for fetal lung maturity due to increased risk of fetal mortality, or after an amniocentesis for delivery prior to 37 weeks gestation. If meconium is present at the time of amniocentesis, delivery is indicated regardless of the fetal lung maturity results. Delivery can proceed without an amniocentesis if the fetal monitoring is nonreassuring. Some providers are now waiting until 38-39 weeks gestation to deliver if there is resolution of pruritus symptoms with treatment and bile acid levels are not significantly elevated (less than 40 mol/L).

• #27 Intrahepatic Cholestasis of Pregnancy: New Insights on an Old Issue – Women’s Healthcare

  https://www.npwomenshealthcare.com/intrahepatic-cholestasis-of-pregnancy-new-insights-on-an-old-issue/

  The efficacy of fetal monitoring to predict or reduce the risk of stillbirth related to ICP is unknown. […] The Society of Maternal-Fetal Medicine recommends initiating antepartum surveillance at a gestational age when delivery would be performed in response to abnormal results (SMFM grade 2C). […] Patients can be reassured that ICP typically resolves spontaneously shortly after delivery and that breastfeeding is not contraindicated. […] Individuals diagnosed with ICP should be counseled on the likelihood of recurrence in subsequent pregnancies, which has been estimated to be up to 90%. […] The sometimes unrelenting and intense pruritis associated with ICP can cause significant distress. Although these symptoms can often be managed, the anxiety surrounding the diagnosis can be more difficult to control. […] Thorough patient counseling and shared decision making regarding patient referral, antenatal surveillance, and delivery planning is imperative for optimal outcomes and can lessen patient anxiety when ICP is diagnosed.

• #28 Treatment for Intrahepatic Cholestasis of Pregnancy – ICP Care

  https://icpcare.org/intrahepatic-cholestasis-pregnancy/treatment/

  It does need to be noted that stillbirth in a cholestasis pregnancy is thought to be a sudden event and that fetal monitoring will not be able to prevent all stillbirths. […] Ursodeoxycholic acid remains the first line of treatment for Intrahepatic Cholestasis of Pregnancy (ICP) according to the Society for Maternal-Fetal Medicine (SMFM). […] The governing boards for OB care in the US still recommend that Ursodeoxycholic acid should continue to be used as a first line treatment based on the lack of harm to mother or fetus, potential benefit in maternal symptoms, and reduction in preterm labor. […] Stillbirth in a pregnancy complicated by cholestasis is thought to be a sudden event that cannot be predicted. […] Most stillbirths occur towards the end of pregnancy and after 37 weeks which is why early delivery is recommended for preventing stillbirth.

• #29 Cholestasis of Pregnancy | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/c/cholestasis-of-pregnancy.html

  Cholestasis of pregnancy is a liver problem. It slows or stops the normal flow of bile from the gallbladder. This causes itching and yellowing of your skin, eyes, and mucous membranes (jaundice). Cholestasis sometimes starts in early pregnancy. But it is more common in the second and third trimesters. It most often goes away within a few days after delivery. The high levels of bile may cause serious problems for your developing baby (fetus). […] The goals of treating cholestasis of pregnancy are to relieve the itching and prevent complications. Treatment may include: […] The healthcare provider may check your developing baby for any problems. […] You may deliver your baby early, between 37 to 38 weeks of pregnancy. This will lessen the risk to your baby. […] Cholestasis of pregnancy can also lead to vitamin K deficiency. This will need to be treated before you give birth, because it can cause you to bleed too much. […] The goals of treating cholestasis of pregnancy are to relieve itching and prevent complications for your developing baby. […] Babies of women with cholestasis are often delivered early (usually around 37 weeks) because of the risks.

• #30 Cholestasis of pregnancy – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cholestasis-of-pregnancy/diagnosis-treatment/drc-20363258

  To diagnose cholestasis of pregnancy, your pregnancy care provider usually will: […] The goals of treatment for cholestasis of pregnancy are to ease itching and prevent complications in your baby. […] To soothe intense itching, your pregnancy care provider may recommend: […] Cholestasis of pregnancy can potentially cause complications to your pregnancy. Your pregnancy care provider may recommend close monitoring of your baby while you’re pregnant. […] Even if prenatal tests are within standard limits, your pregnancy care provider may suggest inducing labor before your due date. Early term delivery, around 37 weeks, may lower the risk of stillbirth. […] A history of cholestasis of pregnancy may increase the risk of symptoms returning with contraceptives that contain estrogen, so other methods of birth control are generally recommended. […] Work with your pregnancy care provider to make sure that you and your baby receive the best possible care for this condition.

• #31 Cholestasis Of Pregnancy: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17901-cholestasis-of-pregnancy

  Cholestasis of pregnancy is a liver disease that can develop late in pregnancy. The main symptom of cholestasis is severe itching. Cholestasis of pregnancy typically goes away after your baby is born. […] Cholestasis of pregnancy is a liver condition that causes severe itching late in pregnancy. Its also known as intrahepatic cholestasis of pregnancy (ICP) or obstetric cholestasis. […] Cholestasis of pregnancy can cause complications for you and the fetus. To lower the risk of complications, your pregnancy care provider may monitor you closely for the remainder of your pregnancy. […] Your pregnancy care provider will monitor you closely to ensure cholestasis doesnt harm you or the fetus. […] Healthcare providers use a medication called ursodeoxycholic acid (UDCA, ursodiol or Actigall) to treat cholestasis of pregnancy. This medicine can improve your livers ability to function and reduce bile levels in your blood.

• #32 Treatment for Intrahepatic Cholestasis of Pregnancy – ICP Care

  https://icpcare.org/intrahepatic-cholestasis-pregnancy/treatment/

  It does need to be noted that stillbirth in a cholestasis pregnancy is thought to be a sudden event and that fetal monitoring will not be able to prevent all stillbirths. […] Ursodeoxycholic acid remains the first line of treatment for Intrahepatic Cholestasis of Pregnancy (ICP) according to the Society for Maternal-Fetal Medicine (SMFM). […] The governing boards for OB care in the US still recommend that Ursodeoxycholic acid should continue to be used as a first line treatment based on the lack of harm to mother or fetus, potential benefit in maternal symptoms, and reduction in preterm labor. […] Stillbirth in a pregnancy complicated by cholestasis is thought to be a sudden event that cannot be predicted. […] Most stillbirths occur towards the end of pregnancy and after 37 weeks which is why early delivery is recommended for preventing stillbirth.

• #33 Intrahepatic Cholestasis of Pregnancy

  https://liverfoundation.org/liver-diseases/complications-of-liver-disease/intrahepatic-cholestasis-of-pregnancy-icp/

  Stillbirth tends to occur in the last few weeks of pregnancy. The reason this occurs is not completely understood although it is thought to be due to a cardiac arrhythmia caused by the elevated bile acids. […] Symptoms can vary in severity and type, but the most common ones include: Itching all over, but often more severe on palms and soles of the feet. The itching can be recurrent or constant. Many women find that it is worse at night and it disturbs their sleep. […] Despite the possible outcomes of ICP, proper treatment provides a great degree of reduction in both fetal risk and maternal symptoms. The two main treatments are with a medication called ursodeoxycholic acid and proper delivery timing. […] Ursodeoxycholic Acid (UDCA), also known as Actigall or Ursodiol or Urso is currently the front-line medication for the treatment of ICP. UDCA is a naturally occurring bile acid that improves liver function and may help reduce total bile acid concentration in the bloodstream. […] The other part of management is with proper timing of delivery. Delivery recommendations are based on bile acid levels as risks increase as bile acids become more elevated.

• #34 Intrahepatic cholestasis of pregnancy – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/800

  The risk of stillbirth is increased for pregnant women with total serum bile acid concentrations of 100 micromol/L, and so delivery should be offered to these women at 35 to 36 gestational weeks. […] Treatment with ursodeoxycholic acid does not effectively reduce total serum bile acid concentrations or clearly prevent stillbirth. However, it does cause a marginal improvement in maternal itch, decrease alanine aminotransferase concentrations, and reduce the risk of spontaneous preterm birth in women with serum bile acid concentrations of 40 micromol/L.

• #35 Cholestasis of Pregnancy: Causes, Symptoms, & Treatment | Zaya

  https://zayacare.com/blog/cholestasis-of-pregnancy/

  Cholestasis of pregnancy is treatable. If you talk to your healthcare provider when you first notice the symptoms, treatment may help prevent complications. […] The best-known treatment for cholestasis of pregnancy is called ursodeoxycholic acid. The drug has very specific effects to help this disorder. When taken orally at 100 milligrams three times daily, it stimulates the transfer of bile acids out of the fetus circulation and back into the mothers. […] Other treatments include Vitamin K injections to prevent bleeding complications. […] Ultimately, the delivery of the baby is necessary if there is fetal distress or risk of complications should the pregnancy be maintained. Inducing labor or cesarean section solves the problem if the baby is mature enough for birth. […] A term pregnancy is about 37 to 38 weeks gestation. If your bile acid levels remain high, your doctor may elect to induce labor at 37 weeks to help ease your symptoms more quickly and prevent fetal complications seen with cholestasis of pregnancy.

• #36 Obstetric Outcome in Women with Intrahepatic Cholestasis: A 3-year Study in a Tertiary Care Hospital in Bengaluru

  https://www.jsafog.com/abstractArticleContentBrowse/JSAFOG/16957/JPJ/fullText

  The frequency of intrahepatic cholestasis of pregnancy (ICP) was 60 among 8319 deliveries (7.21%). […] A higher incidence of meconium-stained amniotic fluid (25% vs 6.7%) was noted at delivery. […] The cesarean section rate was 41.7% vs 23.3%. […] Early diagnosis was done with liver function tests (aminotransferases) and urinary bile salts and bile pigments. […] In most of the cases, antihistaminics and emollients relieved the symptoms. […] Ursodeoxycholic acid (UDCA) treatment is found to be effective in reducing the persistent pruritus. […] The treatment with ursodeoxycholic acid (UDCA) could decrease maternal bile acid concentrations and improve fetal outcomes. […] Current pharmacological treatment includes the use of UDCA upon diagnosis of ICP. […] In a meta analysis, it was shown that UDCA was not only effective in reducing pruritus and improving liver tests, but also improved the maternal and perinatal outcome in patients with ICP.

• #37 Intrahepatic cholestasis of pregnancy – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/800

  The risk of stillbirth is increased for pregnant women with total serum bile acid concentrations of 100 micromol/L, and so delivery should be offered to these women at 35 to 36 gestational weeks. […] Treatment with ursodeoxycholic acid does not effectively reduce total serum bile acid concentrations or clearly prevent stillbirth. However, it does cause a marginal improvement in maternal itch, decrease alanine aminotransferase concentrations, and reduce the risk of spontaneous preterm birth in women with serum bile acid concentrations of 40 micromol/L.

• #38 Cholestasis of Pregnancy: Causes, Symptoms, & Treatment | Zaya

  https://zayacare.com/blog/cholestasis-of-pregnancy/

  Cholestasis of pregnancy is treatable. If you talk to your healthcare provider when you first notice the symptoms, treatment may help prevent complications. […] The best-known treatment for cholestasis of pregnancy is called ursodeoxycholic acid. The drug has very specific effects to help this disorder. When taken orally at 100 milligrams three times daily, it stimulates the transfer of bile acids out of the fetus circulation and back into the mothers. […] Other treatments include Vitamin K injections to prevent bleeding complications. […] Ultimately, the delivery of the baby is necessary if there is fetal distress or risk of complications should the pregnancy be maintained. Inducing labor or cesarean section solves the problem if the baby is mature enough for birth. […] A term pregnancy is about 37 to 38 weeks gestation. If your bile acid levels remain high, your doctor may elect to induce labor at 37 weeks to help ease your symptoms more quickly and prevent fetal complications seen with cholestasis of pregnancy.

• #39 Intrahepatic Cholestasis of Pregnancy Treatment & Management: Medical Care, Prevention

  https://emedicine.medscape.com/article/1562288-treatment

  Guidelines from the Society for Maternal-Fetal Medicine (SMFM) recommend delivery at 36-39 weeks of gestation for patients with ICP and bile acid levels lower than 100 mol/L and delivery at 36 weeks gestation if bile acid levels are 100 mol/L or higher. […] Several authorities recommend up to weekly bile acid measurement based on the severity of the disease, as well as in patients with risk factors for developing severe disease (such as tobacco use, pregestational diabetes mellitus, and prior cholecystectomy). […] Patients should be closely monitored for pruritus throughout pregnancy and UDCA should be initiated at the first signs of ICP even prior to receipt of the laboratory results.

• #40 Maternal and fetal outcome in intrahepatic cholestasis of pregnancy at tertiary care institute of North India – Indian Journal of Medical Sciences

  https://ijmsweb.com/maternal-and-fetal-outcome-in-intrahepatic-cholestasis-of-pregnancy-at-tertiary-care-institute-of-north-india/

  Itching over whole body was the predominant presenting complaints of cholestasis of pregnancy. […] Diagnosis should be supported by bile acids in women with normal liver enzymes to decrease the cost of investigations. […] Early termination of pregnancy between 36 and 37 weeks can be considered in women with bile acids 40 mol/L and in non-compliant patients on UDCA treatment. […] There was no correlation found between cholestasis of pregnancy with preterm labor and meconium-stained liquor in the present study. […] All confirmed cases of IHCP were advised to take ursodeoxycholic acid (UDCA) 1015 mg/kg/day, with a maximum dose of 300 mg 8 hourly by oral route. […] Fetal surveillance was done in confirmed cases with weekly biophysical profile till delivery. […] Induction of labor was done in 64.6% versus 18.8% patients in cases and control, respectively.

• #41 Cholestasis of Pregnancy: Causes, Symptoms & Treatment

  https://americanpregnancy.org/healthy-pregnancy/pregnancy-complications/cholestasis-of-pregnancy/?sw_cache=rebuild

  Cholestasis may increase the risks for fetal distress, preterm birth, or stillbirth. A developing baby relies on the mother’s liver to remove bile acids from the blood; therefore, the elevated levels of maternal bile cause stress on the baby’s liver. Women with cholestasis should be monitored closely and serious consideration should be given to inducing labor once the baby’s lungs have reached maturity. […] The treatment goals for cholestasis of pregnancy are to relieve itching. Make sure you speak with your healthcare provider before taking any medications or supplements. Some treatment options include: Topical anti-itch medications or medication with corticosteroids […] Medication to decrease the concentration of bile acids such as ursodeoxycholic acid […] Cold baths and ice water slow down the flow of blood in the body by decreasing the temperature […] Dexamethasone is a steroid that increases the maturity of the baby’s lungs […] Vitamin K supplements administered to the mother before delivery and again once the baby is born to prevent intracranial hemorrhaging […] Dandelion Root and Milk Thistle are natural substances that are beneficial to the liver (talk to your healthcare provider before taking these) […] Bi-weekly non-stress tests which involve fetal heart monitoring and contraction recordings […] Regular blood tests monitoring both bile serum levels and liver function.

• #42 Intrahepatic cholestasis of pregnancy | RCOG

  https://www.rcog.org.uk/for-the-public/browse-our-patient-information/intrahepatic-cholestasis-of-pregnancy/

  ICP is a condition that affects how your liver works when you are pregnant. It is sometimes called obstetric cholestasis. […] Your ICP will be monitored with regular blood tests to check your liver function and the levels of bile acids in your blood. […] Once you have been diagnosed with ICP, you should be under the care of an obstetrician. Your blood tests will usually be repeated after one week and an individualised plan of care will be made for you depending on your circumstances. […] Treatments to improve your itching are of limited benefit but might include: Skin creams such as aqueous cream, with or without the addition of menthol; Antihistamines, which may help you sleep at night; Some women have found that having cool baths and wearing loose-fitting cotton clothing helps to reduce the itching.

• #43 Intrahepatic cholestasis of pregnancy – British Liver Trust

  https://britishlivertrust.org.uk/information-and-support/liver-conditions/intrahepatic-cholestasis-pregnancy/

  Intrahepatic cholestasis of pregnancy is a liver condition that happens in about 1 in every 150 pregnancies. […] The main symptom is itching. You might hear this called pruritus by health professionals such as doctors and midwives. […] If you are more than 20 weeks pregnant and have itching that is not linked to a rash, then you should contact your maternity care team. […] If you have ICP, your maternity care should come from a consultant led team. […] Some people will need to have weekly blood tests to check on their bile acid level. […] Even though it is not harmful, itching can be very difficult to cope with. […] Several antihistamines are safe to take if you are pregnant. […] You might also hear this called urso or UDCA. […] The evidence for using Ursodeoxycholic acid is unclear.

• #44 Cholestasis of Pregnancy: Causes, Symptoms & Treatment

  https://americanpregnancy.org/healthy-pregnancy/pregnancy-complications/cholestasis-of-pregnancy/?sw_cache=rebuild

  Cholestasis may increase the risks for fetal distress, preterm birth, or stillbirth. A developing baby relies on the mother’s liver to remove bile acids from the blood; therefore, the elevated levels of maternal bile cause stress on the baby’s liver. Women with cholestasis should be monitored closely and serious consideration should be given to inducing labor once the baby’s lungs have reached maturity. […] The treatment goals for cholestasis of pregnancy are to relieve itching. Make sure you speak with your healthcare provider before taking any medications or supplements. Some treatment options include: Topical anti-itch medications or medication with corticosteroids […] Medication to decrease the concentration of bile acids such as ursodeoxycholic acid […] Cold baths and ice water slow down the flow of blood in the body by decreasing the temperature […] Dexamethasone is a steroid that increases the maturity of the baby’s lungs […] Vitamin K supplements administered to the mother before delivery and again once the baby is born to prevent intracranial hemorrhaging […] Dandelion Root and Milk Thistle are natural substances that are beneficial to the liver (talk to your healthcare provider before taking these) […] Bi-weekly non-stress tests which involve fetal heart monitoring and contraction recordings […] Regular blood tests monitoring both bile serum levels and liver function.

• #45 Cholestasis of Pregnancy: Causes, Symptoms & Treatment

  https://americanpregnancy.org/healthy-pregnancy/pregnancy-complications/cholestasis-of-pregnancy/?sw_cache=rebuild

  Cholestasis may increase the risks for fetal distress, preterm birth, or stillbirth. A developing baby relies on the mother’s liver to remove bile acids from the blood; therefore, the elevated levels of maternal bile cause stress on the baby’s liver. Women with cholestasis should be monitored closely and serious consideration should be given to inducing labor once the baby’s lungs have reached maturity. […] The treatment goals for cholestasis of pregnancy are to relieve itching. Make sure you speak with your healthcare provider before taking any medications or supplements. Some treatment options include: Topical anti-itch medications or medication with corticosteroids […] Medication to decrease the concentration of bile acids such as ursodeoxycholic acid […] Cold baths and ice water slow down the flow of blood in the body by decreasing the temperature […] Dexamethasone is a steroid that increases the maturity of the baby’s lungs […] Vitamin K supplements administered to the mother before delivery and again once the baby is born to prevent intracranial hemorrhaging […] Dandelion Root and Milk Thistle are natural substances that are beneficial to the liver (talk to your healthcare provider before taking these) […] Bi-weekly non-stress tests which involve fetal heart monitoring and contraction recordings […] Regular blood tests monitoring both bile serum levels and liver function.

• #46 Cholestasis of Pregnancy | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/c/cholestasis-of-pregnancy.html

  Cholestasis of pregnancy is a liver problem. It slows or stops the normal flow of bile from the gallbladder. This causes itching and yellowing of your skin, eyes, and mucous membranes (jaundice). Cholestasis sometimes starts in early pregnancy. But it is more common in the second and third trimesters. It most often goes away within a few days after delivery. The high levels of bile may cause serious problems for your developing baby (fetus). […] The goals of treating cholestasis of pregnancy are to relieve the itching and prevent complications. Treatment may include: […] The healthcare provider may check your developing baby for any problems. […] You may deliver your baby early, between 37 to 38 weeks of pregnancy. This will lessen the risk to your baby. […] Cholestasis of pregnancy can also lead to vitamin K deficiency. This will need to be treated before you give birth, because it can cause you to bleed too much. […] The goals of treating cholestasis of pregnancy are to relieve itching and prevent complications for your developing baby. […] Babies of women with cholestasis are often delivered early (usually around 37 weeks) because of the risks.

• #47 Cholestasis of Pregnancy: Causes, Symptoms & Treatment

  https://americanpregnancy.org/healthy-pregnancy/pregnancy-complications/cholestasis-of-pregnancy/?sw_cache=rebuild

  Cholestasis may increase the risks for fetal distress, preterm birth, or stillbirth. A developing baby relies on the mother’s liver to remove bile acids from the blood; therefore, the elevated levels of maternal bile cause stress on the baby’s liver. Women with cholestasis should be monitored closely and serious consideration should be given to inducing labor once the baby’s lungs have reached maturity. […] The treatment goals for cholestasis of pregnancy are to relieve itching. Make sure you speak with your healthcare provider before taking any medications or supplements. Some treatment options include: Topical anti-itch medications or medication with corticosteroids […] Medication to decrease the concentration of bile acids such as ursodeoxycholic acid […] Cold baths and ice water slow down the flow of blood in the body by decreasing the temperature […] Dexamethasone is a steroid that increases the maturity of the baby’s lungs […] Vitamin K supplements administered to the mother before delivery and again once the baby is born to prevent intracranial hemorrhaging […] Dandelion Root and Milk Thistle are natural substances that are beneficial to the liver (talk to your healthcare provider before taking these) […] Bi-weekly non-stress tests which involve fetal heart monitoring and contraction recordings […] Regular blood tests monitoring both bile serum levels and liver function.

• #48 Cholestasis of Pregnancy: Causes, Symptoms & Treatment

  https://americanpregnancy.org/healthy-pregnancy/pregnancy-complications/cholestasis-of-pregnancy/?sw_cache=rebuild

  Treatment for cholestasis of pregnancy needs to be determined by your physician, who will take the following criteria into consideration: Your pregnancy, overall health, and medical history […] The extent of the disease […] Your tolerance for specific medications, procedures, or therapies […] Expectations for the course of the disease […] Your opinion or preference. […] Treatments that should not be used for cholestasis include: Antihistamines […] Aveeno and Oatmeal Bath. […] It is nearly impossible to know whether a woman will experience cholestasis in future pregnancies. Some sources claim that women who have had cholestasis of pregnancy have up to a 90% chance of having this repeat in future pregnancies, but the research is not conclusive. If you plan on getting pregnant again, talk to your healthcare provider about steps you can take to promote a healthy pregnancy, or if there are any ways to prevent ICP.

• #49 Cholestasis of Pregnancy Information & Treatment

  https://www.columbiadoctors.org/health-library/condition/cholestasis-pregnancy/

  Cholestasis of pregnancy is a liver problem that happens when the flow of bile slows down or is blocked. Bile then builds up in the liver and enters the bloodstream. It can make the skin very itchy. Home treatment and medicine can relieve symptoms. […] Your doctor may prescribe medicine. Medicine can help reduce bile acid levels and relieve itching. Your doctor also will want to watch you and your baby closely. To keep you both as healthy as possible, your doctor may recommend an early delivery. […] Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. […] If your doctor prescribes them, use creams or pills to help with itching. […] Use calamine lotion on itchy areas. […] Avoid hot showers or baths. Hot water can make itching worse. […] After bathing, pat excess water off your skin. Then apply moisturizer before your skin dries completely. […] Try keeping your moisturizer in the refrigerator. It may feel better on your skin.

• #50 Intrahepatic cholestasis of pregnancy | RCOG

  https://www.rcog.org.uk/for-the-public/browse-our-patient-information/intrahepatic-cholestasis-of-pregnancy/

  ICP is a condition that affects how your liver works when you are pregnant. It is sometimes called obstetric cholestasis. […] Your ICP will be monitored with regular blood tests to check your liver function and the levels of bile acids in your blood. […] Once you have been diagnosed with ICP, you should be under the care of an obstetrician. Your blood tests will usually be repeated after one week and an individualised plan of care will be made for you depending on your circumstances. […] Treatments to improve your itching are of limited benefit but might include: Skin creams such as aqueous cream, with or without the addition of menthol; Antihistamines, which may help you sleep at night; Some women have found that having cool baths and wearing loose-fitting cotton clothing helps to reduce the itching.

• #51 Obstetric Cholestasis – Saolta Maternity Services

  https://www.uhgmaternity.com/pregnancy/obstetric-cholestasis/

  There is no cure for obstetric cholestasis except the birth of your baby. Treatment may ease symptoms for most women. Treatments might include: 1. Cool baths. 2. Loose cotton clothing. 3. Skin creams and ointments to relieve the itching may provide temporary relief. Your doctor/midwife will advise you on these. […] You will have an opportunity to discuss the options of having labour induced after 37 weeks of pregnancy, particularly if your symptoms are severe or your blood tests are very abnormal. Early induction (before 37 weeks) may carry an increased chance of caesarean section and an increased chance of your baby being admitted to the special care baby unit with problems of being born early. […] Obstetric cholestasis gets better after birth. However, you should have a follow-up appointment with a healthcare professional with knowledge of obstetric cholestasis 6-8 weeks after the birth of your baby. The purpose of your follow-up is to ensure that your itching has gone away and that your liver is working normally. Continuing symptoms and abnormal liver function tests may suggest a different problem after all and you should then be referred to a specialist.

• #52 Cholestasis of Pregnancy Information & Treatment

  https://www.columbiadoctors.org/health-library/condition/cholestasis-pregnancy/

  Cholestasis of pregnancy is a liver problem that happens when the flow of bile slows down or is blocked. Bile then builds up in the liver and enters the bloodstream. It can make the skin very itchy. Home treatment and medicine can relieve symptoms. […] Your doctor may prescribe medicine. Medicine can help reduce bile acid levels and relieve itching. Your doctor also will want to watch you and your baby closely. To keep you both as healthy as possible, your doctor may recommend an early delivery. […] Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. […] If your doctor prescribes them, use creams or pills to help with itching. […] Use calamine lotion on itchy areas. […] Avoid hot showers or baths. Hot water can make itching worse. […] After bathing, pat excess water off your skin. Then apply moisturizer before your skin dries completely. […] Try keeping your moisturizer in the refrigerator. It may feel better on your skin.

• #53 Obstetric Cholestasis – Saolta Maternity Services

  https://www.uhgmaternity.com/pregnancy/obstetric-cholestasis/

  There is no cure for obstetric cholestasis except the birth of your baby. Treatment may ease symptoms for most women. Treatments might include: 1. Cool baths. 2. Loose cotton clothing. 3. Skin creams and ointments to relieve the itching may provide temporary relief. Your doctor/midwife will advise you on these. […] You will have an opportunity to discuss the options of having labour induced after 37 weeks of pregnancy, particularly if your symptoms are severe or your blood tests are very abnormal. Early induction (before 37 weeks) may carry an increased chance of caesarean section and an increased chance of your baby being admitted to the special care baby unit with problems of being born early. […] Obstetric cholestasis gets better after birth. However, you should have a follow-up appointment with a healthcare professional with knowledge of obstetric cholestasis 6-8 weeks after the birth of your baby. The purpose of your follow-up is to ensure that your itching has gone away and that your liver is working normally. Continuing symptoms and abnormal liver function tests may suggest a different problem after all and you should then be referred to a specialist.

• #54 Itching and intrahepatic cholestasis of pregnancy – NHS

  https://www.nhs.uk/pregnancy/related-conditions/complications/itching-and-intrahepatic-cholestasis/

  Itching can be a symptom of a liver condition called intrahepatic cholestasis of pregnancy (ICP), also known as obstetric cholestasis (OC). […] ICP needs medical attention. It affects around 1 in 140 pregnant women in the UK. […] If you have ICP, you will probably be advised to give birth in hospital under a consultant-led maternity team. […] If you are diagnosed with ICP, you will have regular liver blood tests (LFTs) and bile acid measurement tests so your doctor can monitor your condition. […] Creams, such as aqueous cream with menthol, are safe to use in pregnancy and can provide some relief from itching. […] A medicine called ursodeoxycholic acid (UDCA) can be prescribed to try to relieve itching. […] If you are diagnosed with ICP, your midwife and doctor will discuss your health and your options with you.

• #55 Cholestasis of Pregnancy Information & Treatment

  https://www.columbiadoctors.org/health-library/condition/cholestasis-pregnancy/

  Cholestasis of pregnancy is a liver problem that happens when the flow of bile slows down or is blocked. Bile then builds up in the liver and enters the bloodstream. It can make the skin very itchy. Home treatment and medicine can relieve symptoms. […] Your doctor may prescribe medicine. Medicine can help reduce bile acid levels and relieve itching. Your doctor also will want to watch you and your baby closely. To keep you both as healthy as possible, your doctor may recommend an early delivery. […] Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. […] If your doctor prescribes them, use creams or pills to help with itching. […] Use calamine lotion on itchy areas. […] Avoid hot showers or baths. Hot water can make itching worse. […] After bathing, pat excess water off your skin. Then apply moisturizer before your skin dries completely. […] Try keeping your moisturizer in the refrigerator. It may feel better on your skin.

• #56 Cholestasis of Pregnancy Information & Treatment

  https://www.columbiadoctors.org/health-library/condition/cholestasis-pregnancy/

  Cholestasis of pregnancy is a liver problem that happens when the flow of bile slows down or is blocked. Bile then builds up in the liver and enters the bloodstream. It can make the skin very itchy. Home treatment and medicine can relieve symptoms. […] Your doctor may prescribe medicine. Medicine can help reduce bile acid levels and relieve itching. Your doctor also will want to watch you and your baby closely. To keep you both as healthy as possible, your doctor may recommend an early delivery. […] Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. […] If your doctor prescribes them, use creams or pills to help with itching. […] Use calamine lotion on itchy areas. […] Avoid hot showers or baths. Hot water can make itching worse. […] After bathing, pat excess water off your skin. Then apply moisturizer before your skin dries completely. […] Try keeping your moisturizer in the refrigerator. It may feel better on your skin.

• #57 Cholestasis of Pregnancy Information & Treatment

  https://www.columbiadoctors.org/health-library/condition/cholestasis-pregnancy/

  Cholestasis of pregnancy is a liver problem that happens when the flow of bile slows down or is blocked. Bile then builds up in the liver and enters the bloodstream. It can make the skin very itchy. Home treatment and medicine can relieve symptoms. […] Your doctor may prescribe medicine. Medicine can help reduce bile acid levels and relieve itching. Your doctor also will want to watch you and your baby closely. To keep you both as healthy as possible, your doctor may recommend an early delivery. […] Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. […] If your doctor prescribes them, use creams or pills to help with itching. […] Use calamine lotion on itchy areas. […] Avoid hot showers or baths. Hot water can make itching worse. […] After bathing, pat excess water off your skin. Then apply moisturizer before your skin dries completely. […] Try keeping your moisturizer in the refrigerator. It may feel better on your skin.

• #58 Cholestasis of Pregnancy Diet: Foods to Eat & What to Avoid

  https://zayacare.com/blog/cholestasis-of-pregnancy-diet/

  Cholestasis of pregnancy is an uncommon disorder of pregnancy affecting 1 in 150 pregnancies. Cholestasis means that the bile in the liver flows poorly, resulting in low appetite, nausea, and jaundice. Cholestasis of pregnancy can be risky for you and your baby. Your baby might be born early or stillborn. Meconium staining at the time of birth and the potential for lung problems can also happen to your baby if you have this disorder. […] No diet or medication can prevent cholestasis of pregnancy; however, eating right can help a lot. For example, eating plenty of protein and fiber, medium-chain fatty acids, and foods high in vitamins A, C, E, and K may help reduce bile acid during pregnancy. You should also avoid alcohol, highly processed foods, and foods that are high in fat, sugar, and complex carbs.

• #59 Cholestasis of Pregnancy Diet: Foods to Eat & What to Avoid

  https://zayacare.com/blog/cholestasis-of-pregnancy-diet/

  Following some simple dietary recommendations can help your liver function better during the stress of pregnancy and cholestasis. Here are some ways you may be able to reduce bile acid naturally during pregnancy through your diet: Eat plenty of protein. Your liver is responsible for making many blood proteins. You can help by making sure you get key amino acids found in foods high in protein. […] Eat foods with medium-chain fatty acids (MCFAs). Fats absorb very poorly when the bile flow has slowed or stopped. The only fats that absorb relatively easily are medium-chain fatty acids found in higher concentrations in coconut oil and palm kernel oil. […] Consume extra fiber. Toxins in your food can be absorbed by the gut, and because your liver is sluggish, it can’t break them down as easily. Fiber helps bind toxins so that you aren’t as affected by them.

• #60 Cholestasis of Pregnancy Diet: Foods to Eat & What to Avoid

  https://zayacare.com/blog/cholestasis-of-pregnancy-diet/

  Following some simple dietary recommendations can help your liver function better during the stress of pregnancy and cholestasis. Here are some ways you may be able to reduce bile acid naturally during pregnancy through your diet: Eat plenty of protein. Your liver is responsible for making many blood proteins. You can help by making sure you get key amino acids found in foods high in protein. […] Eat foods with medium-chain fatty acids (MCFAs). Fats absorb very poorly when the bile flow has slowed or stopped. The only fats that absorb relatively easily are medium-chain fatty acids found in higher concentrations in coconut oil and palm kernel oil. […] Consume extra fiber. Toxins in your food can be absorbed by the gut, and because your liver is sluggish, it can’t break them down as easily. Fiber helps bind toxins so that you aren’t as affected by them.

• #61 Cholestasis of Pregnancy Diet: Foods to Eat & What to Avoid

  https://zayacare.com/blog/cholestasis-of-pregnancy-diet/

  Following some simple dietary recommendations can help your liver function better during the stress of pregnancy and cholestasis. Here are some ways you may be able to reduce bile acid naturally during pregnancy through your diet: Eat plenty of protein. Your liver is responsible for making many blood proteins. You can help by making sure you get key amino acids found in foods high in protein. […] Eat foods with medium-chain fatty acids (MCFAs). Fats absorb very poorly when the bile flow has slowed or stopped. The only fats that absorb relatively easily are medium-chain fatty acids found in higher concentrations in coconut oil and palm kernel oil. […] Consume extra fiber. Toxins in your food can be absorbed by the gut, and because your liver is sluggish, it can’t break them down as easily. Fiber helps bind toxins so that you aren’t as affected by them.

• #62 Cholestasis of Pregnancy Diet: Foods to Eat & What to Avoid

  https://zayacare.com/blog/cholestasis-of-pregnancy-diet/

  Eat foods high in vitamin K. Vitamin K is a fat-soluble vitamin that needs bile to be absorbed. You need this vitamin for the effective clotting of blood. In order to get enough vitamin K absorbed when you have cholestasis, you should consume more than you normally would. […] Eat extra omega-3 fatty acids. Omega-3 fatty acids will be more challenging to absorb with cholestasis of pregnancy. Do your best by eating foods that have mostly this type of healthy fat. […] Load your diet with vitamins A, C, and E. These are antioxidant vitamins that help your cells heal from stress. […] Avoid alcohol. Alcohol is not recommended during pregnancy anyway, but with cholestasis, you have another reason to avoid it. Alcohol places a huge stress on the liver, so it won’t be advisable to drink even after pregnancy until the cholestasis resolves.

• #63 Cholestasis of Pregnancy Diet: Foods to Eat & What to Avoid

  https://zayacare.com/blog/cholestasis-of-pregnancy-diet/

  Eat foods high in vitamin K. Vitamin K is a fat-soluble vitamin that needs bile to be absorbed. You need this vitamin for the effective clotting of blood. In order to get enough vitamin K absorbed when you have cholestasis, you should consume more than you normally would. […] Eat extra omega-3 fatty acids. Omega-3 fatty acids will be more challenging to absorb with cholestasis of pregnancy. Do your best by eating foods that have mostly this type of healthy fat. […] Load your diet with vitamins A, C, and E. These are antioxidant vitamins that help your cells heal from stress. […] Avoid alcohol. Alcohol is not recommended during pregnancy anyway, but with cholestasis, you have another reason to avoid it. Alcohol places a huge stress on the liver, so it won’t be advisable to drink even after pregnancy until the cholestasis resolves.

• #64 Cholestasis of Pregnancy Diet: Foods to Eat & What to Avoid

  https://zayacare.com/blog/cholestasis-of-pregnancy-diet/

  Eat foods high in vitamin K. Vitamin K is a fat-soluble vitamin that needs bile to be absorbed. You need this vitamin for the effective clotting of blood. In order to get enough vitamin K absorbed when you have cholestasis, you should consume more than you normally would. […] Eat extra omega-3 fatty acids. Omega-3 fatty acids will be more challenging to absorb with cholestasis of pregnancy. Do your best by eating foods that have mostly this type of healthy fat. […] Load your diet with vitamins A, C, and E. These are antioxidant vitamins that help your cells heal from stress. […] Avoid alcohol. Alcohol is not recommended during pregnancy anyway, but with cholestasis, you have another reason to avoid it. Alcohol places a huge stress on the liver, so it won’t be advisable to drink even after pregnancy until the cholestasis resolves.

• #65 Cholestasis of Pregnancy Diet: Foods to Eat & What to Avoid

  https://zayacare.com/blog/cholestasis-of-pregnancy-diet/

  Cholestasis of pregnancy is an uncommon disorder of pregnancy affecting 1 in 150 pregnancies. Cholestasis means that the bile in the liver flows poorly, resulting in low appetite, nausea, and jaundice. Cholestasis of pregnancy can be risky for you and your baby. Your baby might be born early or stillborn. Meconium staining at the time of birth and the potential for lung problems can also happen to your baby if you have this disorder. […] No diet or medication can prevent cholestasis of pregnancy; however, eating right can help a lot. For example, eating plenty of protein and fiber, medium-chain fatty acids, and foods high in vitamins A, C, E, and K may help reduce bile acid during pregnancy. You should also avoid alcohol, highly processed foods, and foods that are high in fat, sugar, and complex carbs.

• #66 Cholestasis of Pregnancy Diet: Foods to Eat & What to Avoid

  https://zayacare.com/blog/cholestasis-of-pregnancy-diet/

  Avoid highly preserved and processed foods. Pesticides and preservatives are chemicals your liver can’t handle when you have cholestasis. Highly processed foods are hard on your system because they contain more of these. […] Cholestasis of pregnancy is uncomfortable and scary. A prenatal nutritionist can provide both information and support. They are trained in advanced nutritional practices and have special training in nutrition for high-risk pregnancies. Your prenatal nutritionist can evaluate your current diet. They will learn your likes and dislikes before working with you to develop a dietary plan that will carry you through your pregnancy. They can help you with meal planning and teach you the best foods to eat while pregnant and ways to eat with cholestasis to reduce your chances of suffering from this illness.

• #67 Treatment for Intrahepatic Cholestasis of Pregnancy – ICP Care

  https://icpcare.org/intrahepatic-cholestasis-pregnancy/treatment/

  It does need to be noted that stillbirth in a cholestasis pregnancy is thought to be a sudden event and that fetal monitoring will not be able to prevent all stillbirths. […] Ursodeoxycholic acid remains the first line of treatment for Intrahepatic Cholestasis of Pregnancy (ICP) according to the Society for Maternal-Fetal Medicine (SMFM). […] The governing boards for OB care in the US still recommend that Ursodeoxycholic acid should continue to be used as a first line treatment based on the lack of harm to mother or fetus, potential benefit in maternal symptoms, and reduction in preterm labor. […] Stillbirth in a pregnancy complicated by cholestasis is thought to be a sudden event that cannot be predicted. […] Most stillbirths occur towards the end of pregnancy and after 37 weeks which is why early delivery is recommended for preventing stillbirth.

• #68 Intrahepatic Cholestasis of Pregnancy Treatment & Management: Medical Care, Prevention

  https://emedicine.medscape.com/article/1562288-treatment

  Guidelines from the Society for Maternal-Fetal Medicine (SMFM) recommend delivery at 36-39 weeks of gestation for patients with ICP and bile acid levels lower than 100 mol/L and delivery at 36 weeks gestation if bile acid levels are 100 mol/L or higher. […] Several authorities recommend up to weekly bile acid measurement based on the severity of the disease, as well as in patients with risk factors for developing severe disease (such as tobacco use, pregestational diabetes mellitus, and prior cholecystectomy). […] Patients should be closely monitored for pruritus throughout pregnancy and UDCA should be initiated at the first signs of ICP even prior to receipt of the laboratory results.

• #69 Navigating Perinatal Challenges: A Comprehensive Review of Cholestasis of Pregnancy and Its Impact on Maternal and Fetal Health

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11109475/

  The decision regarding the delivery timing is a critical aspect of ICP management. Patients with total bile acid levels of 100 mol/L or higher should be offered delivery at 36 0/7 weeks of gestation due to the increased risk of stillbirth around this time. […] These general principles encompass key aspects of managing ICP, focusing on monitoring, treatment, delivery timing, and interventions to optimize outcomes for both the mother and the fetus.

• #70 Intrahepatic cholestasis of pregnancy – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/800

  The risk of stillbirth is increased for pregnant women with total serum bile acid concentrations of 100 micromol/L, and so delivery should be offered to these women at 35 to 36 gestational weeks. […] Treatment with ursodeoxycholic acid does not effectively reduce total serum bile acid concentrations or clearly prevent stillbirth. However, it does cause a marginal improvement in maternal itch, decrease alanine aminotransferase concentrations, and reduce the risk of spontaneous preterm birth in women with serum bile acid concentrations of 40 micromol/L.

• #71 Intrahepatic Cholestasis of Pregnancy Treatment & Management: Medical Care, Prevention

  https://emedicine.medscape.com/article/1562288-treatment

  Guidelines from the Society for Maternal-Fetal Medicine (SMFM) recommend delivery at 36-39 weeks of gestation for patients with ICP and bile acid levels lower than 100 mol/L and delivery at 36 weeks gestation if bile acid levels are 100 mol/L or higher. […] Several authorities recommend up to weekly bile acid measurement based on the severity of the disease, as well as in patients with risk factors for developing severe disease (such as tobacco use, pregestational diabetes mellitus, and prior cholecystectomy). […] Patients should be closely monitored for pruritus throughout pregnancy and UDCA should be initiated at the first signs of ICP even prior to receipt of the laboratory results.

• #72 Intrahepatic Cholestasis of Pregnancy — High Risk Pregnancy Information

  https://www.highriskpregnancyinfo.org/intrahepatic-cholestasis-of-pregnancy

  Ursodeoxycholic acid (UDCA) is the most commonly used drug to treat ICP. It treats the symptoms of ICP and reduces the risk of fetal complications. […] Antenatal testing is done to monitor fetal well-being. […] Early delivery is a way to prevent possible stillbirth. If bile acid levels are very high (100 umol/L or greater), delivery is recommended at 36 weeks and sometimes earlier in some situations. With lower bile acid levels, delivery is recommended between 36 and 39 weeks. […] The decision about when to have your baby to prevent possible stillbirth should be balanced against the risks that preterm babies face. […] Management includes medication, antenatal testing, and early delivery.

• #73 Maternal and fetal outcome in intrahepatic cholestasis of pregnancy at tertiary care institute of North India – Indian Journal of Medical Sciences

  https://ijmsweb.com/maternal-and-fetal-outcome-in-intrahepatic-cholestasis-of-pregnancy-at-tertiary-care-institute-of-north-india/

  There was a significant difference found in rate of total cesarean section 34% versus 24% in the case and control groups, respectively. […] The present study did not find any significant difference in preterm birth between both the groups that may be explained by the beneficial effect of UDCA treatment. […] There is a risk of intrauterine fetal demise probably due to sudden fetal arrhythmia and spasm of chorionic surface vessels. […] In the present study, intrauterine fetal demise occurred in two patients who did not receive UDCA treatment and had bile acids 40 mmol/l. […] Early termination of pregnancy at 3738 weeks is advised in whom liver enzymes/bile acids and symptoms get resolved with UDCA whereas earlier induction can be advocated in cases with intense itching and persistently raised liver enzymes/bile acids for favorable fetal outcome.

• #74 Intrahepatic Cholestasis of Pregnancy — High Risk Pregnancy Information

  https://www.highriskpregnancyinfo.org/intrahepatic-cholestasis-of-pregnancy

  Ursodeoxycholic acid (UDCA) is the most commonly used drug to treat ICP. It treats the symptoms of ICP and reduces the risk of fetal complications. […] Antenatal testing is done to monitor fetal well-being. […] Early delivery is a way to prevent possible stillbirth. If bile acid levels are very high (100 umol/L or greater), delivery is recommended at 36 weeks and sometimes earlier in some situations. With lower bile acid levels, delivery is recommended between 36 and 39 weeks. […] The decision about when to have your baby to prevent possible stillbirth should be balanced against the risks that preterm babies face. […] Management includes medication, antenatal testing, and early delivery.

• #75 Maternal and fetal outcome in intrahepatic cholestasis of pregnancy at tertiary care institute of North India – Indian Journal of Medical Sciences

  https://ijmsweb.com/maternal-and-fetal-outcome-in-intrahepatic-cholestasis-of-pregnancy-at-tertiary-care-institute-of-north-india/

  There was a significant difference found in rate of total cesarean section 34% versus 24% in the case and control groups, respectively. […] The present study did not find any significant difference in preterm birth between both the groups that may be explained by the beneficial effect of UDCA treatment. […] There is a risk of intrauterine fetal demise probably due to sudden fetal arrhythmia and spasm of chorionic surface vessels. […] In the present study, intrauterine fetal demise occurred in two patients who did not receive UDCA treatment and had bile acids 40 mmol/l. […] Early termination of pregnancy at 3738 weeks is advised in whom liver enzymes/bile acids and symptoms get resolved with UDCA whereas earlier induction can be advocated in cases with intense itching and persistently raised liver enzymes/bile acids for favorable fetal outcome.

• #76 Intrahepatic Cholestasis of Pregnancy Treatment & Management: Medical Care, Prevention

  https://emedicine.medscape.com/article/1562288-treatment

  Antenatal testing, including umbilical artery Doppler studies, biophysical profile (BPP), and nonstress tests, have all been performed to reduce the risk of stillbirth. Patients with intrahepatic cholestasis of pregnancy (ICP) should have regular antenatal testing (starting at 32-34 weeks) with consideration for Doppler flow studies of the umbilical artery. […] Delivery is commonly recommended at 37 weeks without an amniocentesis for fetal lung maturity due to increased risk of fetal mortality, or after an amniocentesis for delivery prior to 37 weeks gestation. If meconium is present at the time of amniocentesis, delivery is indicated regardless of the fetal lung maturity results. Delivery can proceed without an amniocentesis if the fetal monitoring is nonreassuring. Some providers are now waiting until 38-39 weeks gestation to deliver if there is resolution of pruritus symptoms with treatment and bile acid levels are not significantly elevated (less than 40 mol/L).

• #77 Cholestasis of pregnancy | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/cholestasis-pregnancy

  Cholestasis of pregnancy can potentially cause complications to your pregnancy. Your pregnancy care provider may recommend close monitoring of your baby while you’re pregnant. […] Even if prenatal tests are within standard limits, your pregnancy care provider may suggest inducing labor before your due date. Early term delivery, around 37 weeks, may lower the risk of stillbirth. Vaginal delivery is recommended by induction of labor unless there are other reasons a cesarean section is needed. […] A history of cholestasis of pregnancy may increase the risk of symptoms returning with contraceptives that contain estrogen, so other methods of birth control are generally recommended.

• #78 Obstetric Cholestasis – Saolta Maternity Services

  https://www.uhgmaternity.com/pregnancy/obstetric-cholestasis/

  Obstetric cholestasis is a disorder that affects your liver during pregnancy. This causes a build up of bile acids (yellow / green fluid which help digest fats) in your body. The main symptom is itching of the skin but there is no skin rash. The symptoms get better when your baby has been born. Obstetric cholestasis is uncommon. In the UK, it affects about 7 in 1000 women (less than 1%). Obstetric cholestasis is more common among women of Indian-Asian or Pakistani-Asian origin, with 15 in 1000 women (1.5%) affected. […] Obstetric cholestasis can be a very uncomfortable condition, but it does not have any serious consequences for your health. […] If you have cholestasis you need to be monitored closely. […] Once diagnosed with obstetric cholestasis, you should be under the care of a consultant and have your baby in a consultant-led maternity unit with a neonatal unit. Depending upon your circumstances, you will be advised to have additional antenatal checks. Additional monitoring of your baby may include monitoring your baby’s heart rate (cardiotocography) and ultrasound scans for growth and measuring the amount of fluid around your baby.

• #79 Intrahepatic cholestasis of pregnancy (ICP)

  https://www.medicinesinpregnancy.org/leaflets-a-z/intrahepatic-cholestasis-of-pregnancy-icp/

  Intrahepatic cholestasis of pregnancy (ICP) is a liver problem that occurs in about one in every 100 pregnancies. It can be unpleasant but is usually harmless. Women with ICP will be more closely monitored and may be offered early delivery of the baby. Severe ICP is unusual but can increase the risk of stillbirth. […] Women with ICP will be offered at least weekly blood tests and may be offered early delivery of their baby depending on their bile acid levels. […] It is recommended that pregnant women with ICP receive consultant-led care and have their baby in a hospital unit. […] Women with ICP will be offered extra blood tests to check their bile acid levels and liver function. They may also be offered extra monitoring of the baby, particularly if they are anxious about the baby’s wellbeing. It is recommended that pregnant women with ICP receive consultant-led care and that they give birth in a hospital unit.

• #80 Obstetric Outcome in Women with Intrahepatic Cholestasis: A 3-year Study in a Tertiary Care Hospital in Bengaluru

  https://www.jsafog.com/abstractArticleContentBrowse/JSAFOG/16957/JPJ/fullText

  The frequency of intrahepatic cholestasis of pregnancy (ICP) was 60 among 8319 deliveries (7.21%). […] A higher incidence of meconium-stained amniotic fluid (25% vs 6.7%) was noted at delivery. […] The cesarean section rate was 41.7% vs 23.3%. […] Early diagnosis was done with liver function tests (aminotransferases) and urinary bile salts and bile pigments. […] In most of the cases, antihistaminics and emollients relieved the symptoms. […] Ursodeoxycholic acid (UDCA) treatment is found to be effective in reducing the persistent pruritus. […] The treatment with ursodeoxycholic acid (UDCA) could decrease maternal bile acid concentrations and improve fetal outcomes. […] Current pharmacological treatment includes the use of UDCA upon diagnosis of ICP. […] In a meta analysis, it was shown that UDCA was not only effective in reducing pruritus and improving liver tests, but also improved the maternal and perinatal outcome in patients with ICP.

• #81 Intrahepatic cholestasis of pregnancy | March of Dimes

  https://www.marchofdimes.org/find-support/topics/pregnancy/intrahepatic-cholestasis-pregnancy

  Talk to your provider about treatment for ICP. Your provider may give you prescription medicine called ursodiol (brand names Actigall and Urso). […] If you have ICP, your provider may recommend inducing labor to help prevent complications like stillbirth. Inducing labor is when your provider gives you medicine or breaks your water (amniotic sac) to make your labor begin. […] Itching should stop within a few days of giving birth. Your provider may recommend blood tests after giving birth to check your bile acid levels and make sure your liver is working well.

• #82 Intrahepatic cholestasis of pregnancy | RCOG

  https://www.rcog.org.uk/for-the-public/browse-our-patient-information/intrahepatic-cholestasis-of-pregnancy/

  The recommended timing of your baby’s birth will depend on the level of bile acids in your blood and also whether you have any additional risk factors such as multiple pregnancy, gestational diabetes or pre-eclampsia. […] ICP symptoms get better after birth. It can take several weeks for your blood tests to return to normal. At your 6-week postnatal check your healthcare professional should make sure that your itching has gone away and arrange blood tests to make sure that your liver blood tests and bile acids have returned to normal.

• #83 Obstetric Cholestasis – Saolta Maternity Services

  https://www.uhgmaternity.com/pregnancy/obstetric-cholestasis/

  There is no cure for obstetric cholestasis except the birth of your baby. Treatment may ease symptoms for most women. Treatments might include: 1. Cool baths. 2. Loose cotton clothing. 3. Skin creams and ointments to relieve the itching may provide temporary relief. Your doctor/midwife will advise you on these. […] You will have an opportunity to discuss the options of having labour induced after 37 weeks of pregnancy, particularly if your symptoms are severe or your blood tests are very abnormal. Early induction (before 37 weeks) may carry an increased chance of caesarean section and an increased chance of your baby being admitted to the special care baby unit with problems of being born early. […] Obstetric cholestasis gets better after birth. However, you should have a follow-up appointment with a healthcare professional with knowledge of obstetric cholestasis 6-8 weeks after the birth of your baby. The purpose of your follow-up is to ensure that your itching has gone away and that your liver is working normally. Continuing symptoms and abnormal liver function tests may suggest a different problem after all and you should then be referred to a specialist.

• #84 cholestasis of pregnancy – Nursing Notebook

  https://nursing-notebook.com/en-ie/simplepage.cfm?ID=134611012&linkID=49171

  as a minimum, healthcare practitioners must ensure that LFTs return to normal, pruritus resolves, all investigations carried out during the pregnancy have been reviewed and the mother has fully understood the implications of obstetric cholestasis […] appropriate follow-up should be arranged by a medical practitioner with appropriate skills.

• #85 Cholestasis of pregnancy – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cholestasis-of-pregnancy/diagnosis-treatment/drc-20363258

  To diagnose cholestasis of pregnancy, your pregnancy care provider usually will: […] The goals of treatment for cholestasis of pregnancy are to ease itching and prevent complications in your baby. […] To soothe intense itching, your pregnancy care provider may recommend: […] Cholestasis of pregnancy can potentially cause complications to your pregnancy. Your pregnancy care provider may recommend close monitoring of your baby while you’re pregnant. […] Even if prenatal tests are within standard limits, your pregnancy care provider may suggest inducing labor before your due date. Early term delivery, around 37 weeks, may lower the risk of stillbirth. […] A history of cholestasis of pregnancy may increase the risk of symptoms returning with contraceptives that contain estrogen, so other methods of birth control are generally recommended. […] Work with your pregnancy care provider to make sure that you and your baby receive the best possible care for this condition.

• #86 Obstetric Cholestasis – Saolta Maternity Services

  https://www.uhgmaternity.com/pregnancy/obstetric-cholestasis/

  There is no cure for obstetric cholestasis except the birth of your baby. Treatment may ease symptoms for most women. Treatments might include: 1. Cool baths. 2. Loose cotton clothing. 3. Skin creams and ointments to relieve the itching may provide temporary relief. Your doctor/midwife will advise you on these. […] You will have an opportunity to discuss the options of having labour induced after 37 weeks of pregnancy, particularly if your symptoms are severe or your blood tests are very abnormal. Early induction (before 37 weeks) may carry an increased chance of caesarean section and an increased chance of your baby being admitted to the special care baby unit with problems of being born early. […] Obstetric cholestasis gets better after birth. However, you should have a follow-up appointment with a healthcare professional with knowledge of obstetric cholestasis 6-8 weeks after the birth of your baby. The purpose of your follow-up is to ensure that your itching has gone away and that your liver is working normally. Continuing symptoms and abnormal liver function tests may suggest a different problem after all and you should then be referred to a specialist.

• #87 Cholestasis of Pregnancy: Causes, Symptoms & Treatment

  https://americanpregnancy.org/healthy-pregnancy/pregnancy-complications/cholestasis-of-pregnancy/?sw_cache=rebuild

  Treatment for cholestasis of pregnancy needs to be determined by your physician, who will take the following criteria into consideration: Your pregnancy, overall health, and medical history […] The extent of the disease […] Your tolerance for specific medications, procedures, or therapies […] Expectations for the course of the disease […] Your opinion or preference. […] Treatments that should not be used for cholestasis include: Antihistamines […] Aveeno and Oatmeal Bath. […] It is nearly impossible to know whether a woman will experience cholestasis in future pregnancies. Some sources claim that women who have had cholestasis of pregnancy have up to a 90% chance of having this repeat in future pregnancies, but the research is not conclusive. If you plan on getting pregnant again, talk to your healthcare provider about steps you can take to promote a healthy pregnancy, or if there are any ways to prevent ICP.

• #88 Intrahepatic Cholestasis of Pregnancy: New Insights on an Old Issue – Women’s Healthcare

  https://www.npwomenshealthcare.com/intrahepatic-cholestasis-of-pregnancy-new-insights-on-an-old-issue/

  The efficacy of fetal monitoring to predict or reduce the risk of stillbirth related to ICP is unknown. […] The Society of Maternal-Fetal Medicine recommends initiating antepartum surveillance at a gestational age when delivery would be performed in response to abnormal results (SMFM grade 2C). […] Patients can be reassured that ICP typically resolves spontaneously shortly after delivery and that breastfeeding is not contraindicated. […] Individuals diagnosed with ICP should be counseled on the likelihood of recurrence in subsequent pregnancies, which has been estimated to be up to 90%. […] The sometimes unrelenting and intense pruritis associated with ICP can cause significant distress. Although these symptoms can often be managed, the anxiety surrounding the diagnosis can be more difficult to control. […] Thorough patient counseling and shared decision making regarding patient referral, antenatal surveillance, and delivery planning is imperative for optimal outcomes and can lessen patient anxiety when ICP is diagnosed.

• #89 Intrahepatic cholestasis of pregnancy – British Liver Trust

  https://britishlivertrust.org.uk/information-and-support/liver-conditions/intrahepatic-cholestasis-pregnancy/

  You can ask your local pharmacist to suggest which to try. […] If you have ICP you should have a blood pressure measurement and a urine dip stick test at each of your check-ups. […] It is unlikely that ICP will cause any serious problems for your baby. […] It can increase the risk of your baby being born early. […] You will be advised to have your baby in a hospital maternity ward if your labour is being started early because of ICP. […] ICP should have no long-term effects on your liver or your general health. […] If your test results are normal, this will confirm that your itching was caused by ICP. […] If you get pregnant again you should tell your midwife about your ICP at the booking appointment.

• #90 Cholestasis of Pregnancy: Diagnosis, Symptoms, Treatment, More

  https://www.healthline.com/health/pregnancy/cholestasis-pregnancy

  Your doctor is likely to prescribe a medication known as ursodeoxycholic acid (such as UDCA, Actigall, or Ursodiol) that will reduce the levels of bile salts in your bloodstream. This should relieve the itching. […] If youre wondering, Whats the big deal about some itching? consider this: Cholestasis of pregnancy does pose some risk to your baby, both before and after birth. Possible serious complications of untreated cholestasis can include: preterm birth, fetal distress, breathing problems from inhaling meconium in the amniotic fluid, stillbirth. […] Sometimes the medication works just fine, and your pregnancy can proceed as usual. But in certain cases, your doctor may discuss the possibility of delivering your baby a little ahead of schedule. […] If youve ever had cholestasis with a previous pregnancy, youre at risk for developing it again with a future pregnancy. […] Your healthcare team can monitor your liver function and the level of bile acids or bile salts in your bloodstream from the get-go. […] Typically, cholestasis goes away once youve given birth to your baby. Your bile acid levels will drop back down to normal levels, and the itching will cease.

• #91 Cholestasis Of Pregnancy: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17901-cholestasis-of-pregnancy

  If medication doesnt lower bile levels, your provider may recommend delivering your baby early. Inducing labor around weeks 37 or 38 of pregnancy may reduce the risk of complications of cholestasis of pregnancy. Your provider will monitor the fetus for signs of any potential problems using tests like a biophysical profile or nonstress test. […] Cholestasis of pregnancy may cause complications. You may have problems absorbing vitamin K, which increases the risk of hemorrhage (heavy internal bleeding). Its also associated with preeclampsia and gestational diabetes. […] Your pregnancy care provider may deliver your baby early to decrease the risk of these complications. […] Cholestasis of pregnancy causes severe itching during pregnancy. Your pregnancy care provider will monitor you closely to ensure there are no complications. Cholestasis goes away after your baby is born and isnt usually life-threatening. Your provider may deliver your baby early if its the safest treatment option.

• #92 Cholestasis in Pregnancy – Signs & Treatment – Huggies AU

  https://www.huggies.com.au/pregnancy/pregnancy-health-care/cholestasis

  Close monitoring of the mother and her baby is essential. […] Mothers with Cholestasis are often referred to a specialist obstetric physician who specialises in liver disease during pregnancy. […] If the bile salt level exceeds a certain point, or the liver function is becoming compromised, then admission to hospital for monitoring becomes necessary. […] For the vast majority of women, there are no ongoing liver or health effects from having had Cholestasis. Generally the itch settles with a few days after birth though all symptoms should disappear within four weeks post-partum. It is important for all mothers who have been diagnosed with Cholestasis that they have a thorough check after their baby is born. This is to ensure there is no underlying liver disease.

• #93 Cholestasis of Pregnancy | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/c/cholestasis-of-pregnancy.html

  Cholestasis of pregnancy is a liver problem. It slows or stops the normal flow of bile from the gallbladder. This causes itching and yellowing of your skin, eyes, and mucous membranes (jaundice). Cholestasis sometimes starts in early pregnancy. But it is more common in the second and third trimesters. It most often goes away within a few days after delivery. The high levels of bile may cause serious problems for your developing baby (fetus). […] The goals of treating cholestasis of pregnancy are to relieve the itching and prevent complications. Treatment may include: […] The healthcare provider may check your developing baby for any problems. […] You may deliver your baby early, between 37 to 38 weeks of pregnancy. This will lessen the risk to your baby. […] Cholestasis of pregnancy can also lead to vitamin K deficiency. This will need to be treated before you give birth, because it can cause you to bleed too much. […] The goals of treating cholestasis of pregnancy are to relieve itching and prevent complications for your developing baby. […] Babies of women with cholestasis are often delivered early (usually around 37 weeks) because of the risks.

• #94 Cholestasis of Pregnancy: Causes, Symptoms, & Treatment | Zaya

  https://zayacare.com/blog/cholestasis-of-pregnancy/

  Cholestasis of pregnancy will not generally be harmful to you unless you have low Vitamin K levels and bleeding complications, including postpartum hemorrhage. Similar hemorrhages can occur in the fetal brainoften with dire consequences. […] Because most complications are severe, the doctor will follow the total bile acid levels in the blood. Most complications happen if the level is above 40 millimoles per liter. This is the time when the risks of delivery are less than remaining pregnant.

• #95 Intrahepatic cholestasis of pregnancy – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/800

  Intrahepatic cholestasis of pregnancy (ICP) is characterised by maternal pruritus (itch) and liver dysfunction, with raised total serum bile acid concentrations, in the absence of other contributing liver disorders and restricted to pregnancy. […] The condition is associated with an increased risk of adverse pregnancy outcomes for the newborn, including spontaneous preterm birth, meconium-stained amniotic fluid, neonatal unit admission, and, if the mothers serum bile acid concentrations are elevated to a level of 100 micromol/L, stillbirth. Maternal complications include an increased risk of gestational diabetes and pre-eclampsia, in addition to impaired glucose tolerance and dyslipidaemia. […] The only definitive cure is delivery of the baby. […] Pregnant women with total serum bile acid concentrations of 40 micromol/L and mild itching can be offered symptomatic treatment, such as topical emollients and sedating antihistamines.

• #96 Intrahepatic cholestasis of pregnancy – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/800

  Intrahepatic cholestasis of pregnancy (ICP) is characterised by maternal pruritus (itch) and liver dysfunction, with raised total serum bile acid concentrations, in the absence of other contributing liver disorders and restricted to pregnancy. […] The condition is associated with an increased risk of adverse pregnancy outcomes for the newborn, including spontaneous preterm birth, meconium-stained amniotic fluid, neonatal unit admission, and, if the mothers serum bile acid concentrations are elevated to a level of 100 micromol/L, stillbirth. Maternal complications include an increased risk of gestational diabetes and pre-eclampsia, in addition to impaired glucose tolerance and dyslipidaemia. […] The only definitive cure is delivery of the baby. […] Pregnant women with total serum bile acid concentrations of 40 micromol/L and mild itching can be offered symptomatic treatment, such as topical emollients and sedating antihistamines.

• #97 Intrahepatic cholestasis of pregnancy – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/800

  Intrahepatic cholestasis of pregnancy (ICP) is characterised by maternal pruritus (itch) and liver dysfunction, with raised total serum bile acid concentrations, in the absence of other contributing liver disorders and restricted to pregnancy. […] The condition is associated with an increased risk of adverse pregnancy outcomes for the newborn, including spontaneous preterm birth, meconium-stained amniotic fluid, neonatal unit admission, and, if the mothers serum bile acid concentrations are elevated to a level of 100 micromol/L, stillbirth. Maternal complications include an increased risk of gestational diabetes and pre-eclampsia, in addition to impaired glucose tolerance and dyslipidaemia. […] The only definitive cure is delivery of the baby. […] Pregnant women with total serum bile acid concentrations of 40 micromol/L and mild itching can be offered symptomatic treatment, such as topical emollients and sedating antihistamines.

• #98 Intrahepatic Cholestasis of Pregnancy: New Insights on an Old Issue – Women’s Healthcare

  https://www.npwomenshealthcare.com/intrahepatic-cholestasis-of-pregnancy-new-insights-on-an-old-issue/

  The efficacy of fetal monitoring to predict or reduce the risk of stillbirth related to ICP is unknown. […] The Society of Maternal-Fetal Medicine recommends initiating antepartum surveillance at a gestational age when delivery would be performed in response to abnormal results (SMFM grade 2C). […] Patients can be reassured that ICP typically resolves spontaneously shortly after delivery and that breastfeeding is not contraindicated. […] Individuals diagnosed with ICP should be counseled on the likelihood of recurrence in subsequent pregnancies, which has been estimated to be up to 90%. […] The sometimes unrelenting and intense pruritis associated with ICP can cause significant distress. Although these symptoms can often be managed, the anxiety surrounding the diagnosis can be more difficult to control. […] Thorough patient counseling and shared decision making regarding patient referral, antenatal surveillance, and delivery planning is imperative for optimal outcomes and can lessen patient anxiety when ICP is diagnosed.

• #99 Intrahepatic Cholestasis of Pregnancy

  https://liverfoundation.org/liver-diseases/complications-of-liver-disease/intrahepatic-cholestasis-of-pregnancy-icp/

  ICP poses several risks that are of great concern. It is associated with an increased risk of stillbirth (intrauterine fetal demise), premature labor, respiratory distress in the neonate, meconium staining, preeclampsia and gestational diabetes. […] Cholestasis increases the risk for Respiratory Distress Syndrome after birth (RDS). The elevated bile acids are thought to interfere with the formation of a chemical called surfactant which allows the lungs to expand after birth. There is an increased risk of an infant needing respiratory support after birth. […] ICP has been associated with a substantial rate of preterm birth. There is an increased risk of spontaneous preterm labor, which has been seen in as many as 60% of deliveries in some studies, however with active management most studies report rates of 30%-40%.

• #100 Navigating Perinatal Challenges: A Comprehensive Review of Cholestasis of Pregnancy and Its Impact on Maternal and Fetal Health

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11109475/

  Cholestasis of pregnancy (CP), or intrahepatic CP (ICP), represents a condition peculiar to pregnancy, marked by impaired bile acid flow and consequent accumulation in the maternal bloodstream. Primarily emerging in the third trimester, CP is linked with considerable risks to both the mother and fetus, including heightened incidences of preterm birth, fetal distress, and stillbirth, alongside maternal complications such as intense pruritus and liver dysfunction. […] Given its potential severity, a comprehensive understanding of this condition is essential for effective management and improved outcomes. This review aims to provide a comprehensive overview of CP, focusing on its pathophysiology, clinical manifestations, maternal and fetal complications, management strategies, prognosis, and future research directions.

• #101 Maternal and fetal outcome in intrahepatic cholestasis of pregnancy at tertiary care institute of North India – Indian Journal of Medical Sciences

  https://ijmsweb.com/maternal-and-fetal-outcome-in-intrahepatic-cholestasis-of-pregnancy-at-tertiary-care-institute-of-north-india/

  There was a significant difference found in rate of total cesarean section 34% versus 24% in the case and control groups, respectively. […] The present study did not find any significant difference in preterm birth between both the groups that may be explained by the beneficial effect of UDCA treatment. […] There is a risk of intrauterine fetal demise probably due to sudden fetal arrhythmia and spasm of chorionic surface vessels. […] In the present study, intrauterine fetal demise occurred in two patients who did not receive UDCA treatment and had bile acids 40 mmol/l. […] Early termination of pregnancy at 3738 weeks is advised in whom liver enzymes/bile acids and symptoms get resolved with UDCA whereas earlier induction can be advocated in cases with intense itching and persistently raised liver enzymes/bile acids for favorable fetal outcome.

• #102 Intrahepatic cholestasis of pregnancy: MedlinePlus GeneticsLock

  https://medlineplus.gov/genetics/condition/intrahepatic-cholestasis-of-pregnancy/

  Intrahepatic cholestasis of pregnancy (also called ICP) is a liver disorder that typically occurs during the second half of pregnancy. Cholestasis is a condition that impairs the release of a digestive fluid called bile, which is made and released by the liver. In people with cholestasis, bile builds up in the liver, impairing its function. […] Severe itchiness (pruritus) is typically one of the first symptoms of intrahepatic cholestasis of pregnancy. The itchiness usually begins on the palms of the hands and the soles of the feet before spreading to other parts of the body. Women with intrahepatic cholestasis of pregnancy have a buildup of bile acids in the blood. […] Intrahepatic cholestasis of pregnancy can cause problems for the baby. This condition is associated with an increased risk of premature delivery and breathing problems in the newborn (meconium aspiration). Some infants born to women with intrahepatic cholestasis of pregnancy experience a slow heart rate and a lack of oxygen during delivery (fetal distress). Women with higher levels of bile acids in their blood also have an increased risk of stillbirth.

• #103 Intrahepatic Cholestasis of Pregnancy

  https://liverfoundation.org/liver-diseases/complications-of-liver-disease/intrahepatic-cholestasis-of-pregnancy-icp/

  ICP poses several risks that are of great concern. It is associated with an increased risk of stillbirth (intrauterine fetal demise), premature labor, respiratory distress in the neonate, meconium staining, preeclampsia and gestational diabetes. […] Cholestasis increases the risk for Respiratory Distress Syndrome after birth (RDS). The elevated bile acids are thought to interfere with the formation of a chemical called surfactant which allows the lungs to expand after birth. There is an increased risk of an infant needing respiratory support after birth. […] ICP has been associated with a substantial rate of preterm birth. There is an increased risk of spontaneous preterm labor, which has been seen in as many as 60% of deliveries in some studies, however with active management most studies report rates of 30%-40%.

• #104 Obstetric Outcome in Women with Intrahepatic Cholestasis: A 3-year Study in a Tertiary Care Hospital in Bengaluru

  https://www.jsafog.com/abstractArticleContentBrowse/JSAFOG/16957/JPJ/fullText

  The frequency of intrahepatic cholestasis of pregnancy (ICP) was 60 among 8319 deliveries (7.21%). […] A higher incidence of meconium-stained amniotic fluid (25% vs 6.7%) was noted at delivery. […] The cesarean section rate was 41.7% vs 23.3%. […] Early diagnosis was done with liver function tests (aminotransferases) and urinary bile salts and bile pigments. […] In most of the cases, antihistaminics and emollients relieved the symptoms. […] Ursodeoxycholic acid (UDCA) treatment is found to be effective in reducing the persistent pruritus. […] The treatment with ursodeoxycholic acid (UDCA) could decrease maternal bile acid concentrations and improve fetal outcomes. […] Current pharmacological treatment includes the use of UDCA upon diagnosis of ICP. […] In a meta analysis, it was shown that UDCA was not only effective in reducing pruritus and improving liver tests, but also improved the maternal and perinatal outcome in patients with ICP.

• #105 Intrahepatic Cholestasis of Pregnancy

  https://liverfoundation.org/liver-diseases/complications-of-liver-disease/intrahepatic-cholestasis-of-pregnancy-icp/

  Stillbirth tends to occur in the last few weeks of pregnancy. The reason this occurs is not completely understood although it is thought to be due to a cardiac arrhythmia caused by the elevated bile acids. […] Symptoms can vary in severity and type, but the most common ones include: Itching all over, but often more severe on palms and soles of the feet. The itching can be recurrent or constant. Many women find that it is worse at night and it disturbs their sleep. […] Despite the possible outcomes of ICP, proper treatment provides a great degree of reduction in both fetal risk and maternal symptoms. The two main treatments are with a medication called ursodeoxycholic acid and proper delivery timing. […] Ursodeoxycholic Acid (UDCA), also known as Actigall or Ursodiol or Urso is currently the front-line medication for the treatment of ICP. UDCA is a naturally occurring bile acid that improves liver function and may help reduce total bile acid concentration in the bloodstream. […] The other part of management is with proper timing of delivery. Delivery recommendations are based on bile acid levels as risks increase as bile acids become more elevated.

• #106 Treatment for Intrahepatic Cholestasis of Pregnancy – ICP Care

  https://icpcare.org/intrahepatic-cholestasis-pregnancy/treatment/

  It does need to be noted that stillbirth in a cholestasis pregnancy is thought to be a sudden event and that fetal monitoring will not be able to prevent all stillbirths. […] Ursodeoxycholic acid remains the first line of treatment for Intrahepatic Cholestasis of Pregnancy (ICP) according to the Society for Maternal-Fetal Medicine (SMFM). […] The governing boards for OB care in the US still recommend that Ursodeoxycholic acid should continue to be used as a first line treatment based on the lack of harm to mother or fetus, potential benefit in maternal symptoms, and reduction in preterm labor. […] Stillbirth in a pregnancy complicated by cholestasis is thought to be a sudden event that cannot be predicted. […] Most stillbirths occur towards the end of pregnancy and after 37 weeks which is why early delivery is recommended for preventing stillbirth.

• #107 Helping Those Diagnosed with Intrahepatic Cholestasis of Pregnancy – ICP Care

  https://icpcare.org/

  Dedicated to protecting pregnancies, families, & their unborn babies from Intrahepatic Cholestasis of Pregnancy (ICP) […] A healthy diet during pregnancy is not only critical for your baby’s health and development, but it may help those who experience Intrahepatic Cholestasis of Pregnancy manage their symptoms. […] If you are diagnosed with Intrahepatic Cholestasis of Pregnancy, it can feel overwhelming, scary and isolating. We are committed to providing those affected by ICP with a supportive online community. […] Join the ICP Care Patient Registry to aid research in Intrahepatic Cholestasis of Pregnancy to improve future management. […] ICP Care’s mission is to provide patient support and education, raise public awareness, support the advancement of research and improve health care practices. […] Intervention, treatment & early delivery can make all the difference.

• #108 Pregnancy Intrahepatic Cholestasis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK551503/

  The management of intrahepatic cholestasis of pregnancy (ICP) must be an interprofessional team approach. Typically, whenever feasible, an interprofessional team should include an obstetrician, maternal-fetal medicine specialist (MFM), gastroenterologist, anesthetist, and the nursing team. […] A weekly biophysical profile for fetal health monitoring should take place in patients with ICP with elevated total bile acid level (over 100 micromol/L). Delivery between 36 to 37 weeks should be considered to avoid fetal complications in a patient with severely elevated total bile salt acid levels and other risk factors, as mentioned above. Once the condition gets diagnosed, the patient should be closely monitored by the nurse and obstetrician to ensure that the ICP is not worsening. A team approach to patient management is vital if one wants to improve outcomes.

• #109 Pregnancy Intrahepatic Cholestasis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK551503/

  The management of intrahepatic cholestasis of pregnancy (ICP) must be an interprofessional team approach. Typically, whenever feasible, an interprofessional team should include an obstetrician, maternal-fetal medicine specialist (MFM), gastroenterologist, anesthetist, and the nursing team. […] A weekly biophysical profile for fetal health monitoring should take place in patients with ICP with elevated total bile acid level (over 100 micromol/L). Delivery between 36 to 37 weeks should be considered to avoid fetal complications in a patient with severely elevated total bile salt acid levels and other risk factors, as mentioned above. Once the condition gets diagnosed, the patient should be closely monitored by the nurse and obstetrician to ensure that the ICP is not worsening. A team approach to patient management is vital if one wants to improve outcomes.

• #110 Intrahepatic cholestasis of pregnancy (ICP)

  https://www.medicinesinpregnancy.org/leaflets-a-z/intrahepatic-cholestasis-of-pregnancy-icp/

  Intrahepatic cholestasis of pregnancy (ICP) is a liver problem that occurs in about one in every 100 pregnancies. It can be unpleasant but is usually harmless. Women with ICP will be more closely monitored and may be offered early delivery of the baby. Severe ICP is unusual but can increase the risk of stillbirth. […] Women with ICP will be offered at least weekly blood tests and may be offered early delivery of their baby depending on their bile acid levels. […] It is recommended that pregnant women with ICP receive consultant-led care and have their baby in a hospital unit. […] Women with ICP will be offered extra blood tests to check their bile acid levels and liver function. They may also be offered extra monitoring of the baby, particularly if they are anxious about the baby’s wellbeing. It is recommended that pregnant women with ICP receive consultant-led care and that they give birth in a hospital unit.

• #111 Pregnancy Intrahepatic Cholestasis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK551503/

  The management of intrahepatic cholestasis of pregnancy (ICP) must be an interprofessional team approach. Typically, whenever feasible, an interprofessional team should include an obstetrician, maternal-fetal medicine specialist (MFM), gastroenterologist, anesthetist, and the nursing team. […] A weekly biophysical profile for fetal health monitoring should take place in patients with ICP with elevated total bile acid level (over 100 micromol/L). Delivery between 36 to 37 weeks should be considered to avoid fetal complications in a patient with severely elevated total bile salt acid levels and other risk factors, as mentioned above. Once the condition gets diagnosed, the patient should be closely monitored by the nurse and obstetrician to ensure that the ICP is not worsening. A team approach to patient management is vital if one wants to improve outcomes.

• #112 Pregnancy Intrahepatic Cholestasis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK551503/

  The management of intrahepatic cholestasis of pregnancy (ICP) must be an interprofessional team approach. Typically, whenever feasible, an interprofessional team should include an obstetrician, maternal-fetal medicine specialist (MFM), gastroenterologist, anesthetist, and the nursing team. […] A weekly biophysical profile for fetal health monitoring should take place in patients with ICP with elevated total bile acid level (over 100 micromol/L). Delivery between 36 to 37 weeks should be considered to avoid fetal complications in a patient with severely elevated total bile salt acid levels and other risk factors, as mentioned above. Once the condition gets diagnosed, the patient should be closely monitored by the nurse and obstetrician to ensure that the ICP is not worsening. A team approach to patient management is vital if one wants to improve outcomes.

• #113 Pregnancy Intrahepatic Cholestasis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK551503/

  The management of intrahepatic cholestasis of pregnancy (ICP) must be an interprofessional team approach. Typically, whenever feasible, an interprofessional team should include an obstetrician, maternal-fetal medicine specialist (MFM), gastroenterologist, anesthetist, and the nursing team. […] A weekly biophysical profile for fetal health monitoring should take place in patients with ICP with elevated total bile acid level (over 100 micromol/L). Delivery between 36 to 37 weeks should be considered to avoid fetal complications in a patient with severely elevated total bile salt acid levels and other risk factors, as mentioned above. Once the condition gets diagnosed, the patient should be closely monitored by the nurse and obstetrician to ensure that the ICP is not worsening. A team approach to patient management is vital if one wants to improve outcomes.

• #114 Obstetric Cholestasis – Saolta Maternity Services

  https://www.uhgmaternity.com/pregnancy/obstetric-cholestasis/

  Obstetric cholestasis is a disorder that affects your liver during pregnancy. This causes a build up of bile acids (yellow / green fluid which help digest fats) in your body. The main symptom is itching of the skin but there is no skin rash. The symptoms get better when your baby has been born. Obstetric cholestasis is uncommon. In the UK, it affects about 7 in 1000 women (less than 1%). Obstetric cholestasis is more common among women of Indian-Asian or Pakistani-Asian origin, with 15 in 1000 women (1.5%) affected. […] Obstetric cholestasis can be a very uncomfortable condition, but it does not have any serious consequences for your health. […] If you have cholestasis you need to be monitored closely. […] Once diagnosed with obstetric cholestasis, you should be under the care of a consultant and have your baby in a consultant-led maternity unit with a neonatal unit. Depending upon your circumstances, you will be advised to have additional antenatal checks. Additional monitoring of your baby may include monitoring your baby’s heart rate (cardiotocography) and ultrasound scans for growth and measuring the amount of fluid around your baby.

• #115 Pregnancy Intrahepatic Cholestasis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK551503/

  The management of intrahepatic cholestasis of pregnancy (ICP) must be an interprofessional team approach. Typically, whenever feasible, an interprofessional team should include an obstetrician, maternal-fetal medicine specialist (MFM), gastroenterologist, anesthetist, and the nursing team. […] A weekly biophysical profile for fetal health monitoring should take place in patients with ICP with elevated total bile acid level (over 100 micromol/L). Delivery between 36 to 37 weeks should be considered to avoid fetal complications in a patient with severely elevated total bile salt acid levels and other risk factors, as mentioned above. Once the condition gets diagnosed, the patient should be closely monitored by the nurse and obstetrician to ensure that the ICP is not worsening. A team approach to patient management is vital if one wants to improve outcomes.

• #116 Obstetric Cholestasis – Saolta Maternity Services

  https://www.uhgmaternity.com/pregnancy/obstetric-cholestasis/

  Obstetric cholestasis is a disorder that affects your liver during pregnancy. This causes a build up of bile acids (yellow / green fluid which help digest fats) in your body. The main symptom is itching of the skin but there is no skin rash. The symptoms get better when your baby has been born. Obstetric cholestasis is uncommon. In the UK, it affects about 7 in 1000 women (less than 1%). Obstetric cholestasis is more common among women of Indian-Asian or Pakistani-Asian origin, with 15 in 1000 women (1.5%) affected. […] Obstetric cholestasis can be a very uncomfortable condition, but it does not have any serious consequences for your health. […] If you have cholestasis you need to be monitored closely. […] Once diagnosed with obstetric cholestasis, you should be under the care of a consultant and have your baby in a consultant-led maternity unit with a neonatal unit. Depending upon your circumstances, you will be advised to have additional antenatal checks. Additional monitoring of your baby may include monitoring your baby’s heart rate (cardiotocography) and ultrasound scans for growth and measuring the amount of fluid around your baby.

• #117 Itching and intrahepatic cholestasis of pregnancy – NHS

  https://www.nhs.uk/pregnancy/related-conditions/complications/itching-and-intrahepatic-cholestasis/

  Itching can be a symptom of a liver condition called intrahepatic cholestasis of pregnancy (ICP), also known as obstetric cholestasis (OC). […] ICP needs medical attention. It affects around 1 in 140 pregnant women in the UK. […] If you have ICP, you will probably be advised to give birth in hospital under a consultant-led maternity team. […] If you are diagnosed with ICP, you will have regular liver blood tests (LFTs) and bile acid measurement tests so your doctor can monitor your condition. […] Creams, such as aqueous cream with menthol, are safe to use in pregnancy and can provide some relief from itching. […] A medicine called ursodeoxycholic acid (UDCA) can be prescribed to try to relieve itching. […] If you are diagnosed with ICP, your midwife and doctor will discuss your health and your options with you.

• #118 Intrahepatic Cholestasis of Pregnancy: New Insights on an Old Issue – Women’s Healthcare

  https://www.npwomenshealthcare.com/intrahepatic-cholestasis-of-pregnancy-new-insights-on-an-old-issue/

  The efficacy of fetal monitoring to predict or reduce the risk of stillbirth related to ICP is unknown. […] The Society of Maternal-Fetal Medicine recommends initiating antepartum surveillance at a gestational age when delivery would be performed in response to abnormal results (SMFM grade 2C). […] Patients can be reassured that ICP typically resolves spontaneously shortly after delivery and that breastfeeding is not contraindicated. […] Individuals diagnosed with ICP should be counseled on the likelihood of recurrence in subsequent pregnancies, which has been estimated to be up to 90%. […] The sometimes unrelenting and intense pruritis associated with ICP can cause significant distress. Although these symptoms can often be managed, the anxiety surrounding the diagnosis can be more difficult to control. […] Thorough patient counseling and shared decision making regarding patient referral, antenatal surveillance, and delivery planning is imperative for optimal outcomes and can lessen patient anxiety when ICP is diagnosed.

• #119 Helping Those Diagnosed with Intrahepatic Cholestasis of Pregnancy – ICP Care

  https://icpcare.org/

  Dedicated to protecting pregnancies, families, & their unborn babies from Intrahepatic Cholestasis of Pregnancy (ICP) […] A healthy diet during pregnancy is not only critical for your baby’s health and development, but it may help those who experience Intrahepatic Cholestasis of Pregnancy manage their symptoms. […] If you are diagnosed with Intrahepatic Cholestasis of Pregnancy, it can feel overwhelming, scary and isolating. We are committed to providing those affected by ICP with a supportive online community. […] Join the ICP Care Patient Registry to aid research in Intrahepatic Cholestasis of Pregnancy to improve future management. […] ICP Care’s mission is to provide patient support and education, raise public awareness, support the advancement of research and improve health care practices. […] Intervention, treatment & early delivery can make all the difference.

• #120 Helping Those Diagnosed with Intrahepatic Cholestasis of Pregnancy – ICP Care

  https://icpcare.org/

  Dedicated to protecting pregnancies, families, & their unborn babies from Intrahepatic Cholestasis of Pregnancy (ICP) […] A healthy diet during pregnancy is not only critical for your baby’s health and development, but it may help those who experience Intrahepatic Cholestasis of Pregnancy manage their symptoms. […] If you are diagnosed with Intrahepatic Cholestasis of Pregnancy, it can feel overwhelming, scary and isolating. We are committed to providing those affected by ICP with a supportive online community. […] Join the ICP Care Patient Registry to aid research in Intrahepatic Cholestasis of Pregnancy to improve future management. […] ICP Care’s mission is to provide patient support and education, raise public awareness, support the advancement of research and improve health care practices. […] Intervention, treatment & early delivery can make all the difference.

• #121 Cholestasis of Pregnancy: Causes, Symptoms & Treatment

  https://americanpregnancy.org/healthy-pregnancy/pregnancy-complications/cholestasis-of-pregnancy/?sw_cache=rebuild

  Treatment for cholestasis of pregnancy needs to be determined by your physician, who will take the following criteria into consideration: Your pregnancy, overall health, and medical history […] The extent of the disease […] Your tolerance for specific medications, procedures, or therapies […] Expectations for the course of the disease […] Your opinion or preference. […] Treatments that should not be used for cholestasis include: Antihistamines […] Aveeno and Oatmeal Bath. […] It is nearly impossible to know whether a woman will experience cholestasis in future pregnancies. Some sources claim that women who have had cholestasis of pregnancy have up to a 90% chance of having this repeat in future pregnancies, but the research is not conclusive. If you plan on getting pregnant again, talk to your healthcare provider about steps you can take to promote a healthy pregnancy, or if there are any ways to prevent ICP.

• #122 Helping Those Diagnosed with Intrahepatic Cholestasis of Pregnancy – ICP Care

  https://icpcare.org/

  Dedicated to protecting pregnancies, families, & their unborn babies from Intrahepatic Cholestasis of Pregnancy (ICP) […] A healthy diet during pregnancy is not only critical for your baby’s health and development, but it may help those who experience Intrahepatic Cholestasis of Pregnancy manage their symptoms. […] If you are diagnosed with Intrahepatic Cholestasis of Pregnancy, it can feel overwhelming, scary and isolating. We are committed to providing those affected by ICP with a supportive online community. […] Join the ICP Care Patient Registry to aid research in Intrahepatic Cholestasis of Pregnancy to improve future management. […] ICP Care’s mission is to provide patient support and education, raise public awareness, support the advancement of research and improve health care practices. […] Intervention, treatment & early delivery can make all the difference.

• #123 Intrahepatic Cholestasis of Pregnancy: New Insights on an Old Issue – Women’s Healthcare

  https://www.npwomenshealthcare.com/intrahepatic-cholestasis-of-pregnancy-new-insights-on-an-old-issue/

  The efficacy of fetal monitoring to predict or reduce the risk of stillbirth related to ICP is unknown. […] The Society of Maternal-Fetal Medicine recommends initiating antepartum surveillance at a gestational age when delivery would be performed in response to abnormal results (SMFM grade 2C). […] Patients can be reassured that ICP typically resolves spontaneously shortly after delivery and that breastfeeding is not contraindicated. […] Individuals diagnosed with ICP should be counseled on the likelihood of recurrence in subsequent pregnancies, which has been estimated to be up to 90%. […] The sometimes unrelenting and intense pruritis associated with ICP can cause significant distress. Although these symptoms can often be managed, the anxiety surrounding the diagnosis can be more difficult to control. […] Thorough patient counseling and shared decision making regarding patient referral, antenatal surveillance, and delivery planning is imperative for optimal outcomes and can lessen patient anxiety when ICP is diagnosed.

• #124

  https://www.nursingcenter.com/journalarticle?Article_ID=2726130&Journal_ID=54008&Issue_ID=2725945

  Intrahepatic cholestasis of pregnancy is the most common liver disease of pregnancy. It is characterized by pruitus, elevated levels of maternal serum bile salts, and normal or mildly elevated liver enzymes occurring after 30 weeks of pregnancy. The primary risks associated with this condition include preterm delivery, meconium-stained amniotic fluid, and stillbirth. Management of intrahepatic cholestasis of pregnancy utilizes a 2-prong approach of oral medications and comfort measures along with active management close to term. The goal of active management has been to deliver women between 37 and 39 weeks of gestation in order to prevent the risk of stillbirth. Currently, expert opinions vary as to recommendations for fetal surveillance and induction of labor. Controversy exists as to whether there is an increased incidence of stillbirth between 37 and 39 weeks of gestation. […] This critical clinical review is a comprehensive overview of intrahepatic cholestasis of pregnancy, including background, controversies, and care of the pregnant woman with this condition and how to provide appropriate follow-up care later after delivery.

• #125

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=tw12250

  Cholestasis of pregnancy is a liver condition. […] Cholestasis of pregnancy can cause pregnancy complications. You have a higher chance of: […] Your healthcare provider will want to watch you and your baby more closely, usually with non-stress tests and ultrasounds. […] Follow-up care is a key part of your treatment and safety. […] Be sure to make and go to all appointments, and call your healthcare provider or nurse advice line if you are having problems. […] If your healthcare provider prescribes them, use creams or pills to help with itching. […] Watch for signs of preterm labour. […] Talk to your healthcare provider about how you’re feeling and any concerns you have. […] Call your healthcare provider, midwife, or nurse call line now or seek immediate medical care if: […] Watch closely for changes in your health, and be sure to contact your healthcare provider, midwife, or nurse call line if you have any questions or concerns.

• #126

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=tw12250

  Cholestasis of pregnancy is a liver condition. […] Cholestasis of pregnancy can cause pregnancy complications. You have a higher chance of: […] Your healthcare provider will want to watch you and your baby more closely, usually with non-stress tests and ultrasounds. […] Follow-up care is a key part of your treatment and safety. […] Be sure to make and go to all appointments, and call your healthcare provider or nurse advice line if you are having problems. […] If your healthcare provider prescribes them, use creams or pills to help with itching. […] Watch for signs of preterm labour. […] Talk to your healthcare provider about how you’re feeling and any concerns you have. […] Call your healthcare provider, midwife, or nurse call line now or seek immediate medical care if: […] Watch closely for changes in your health, and be sure to contact your healthcare provider, midwife, or nurse call line if you have any questions or concerns.

• #127 Cholestasis of Pregnancy Information & Treatment

  https://www.columbiadoctors.org/health-library/condition/cholestasis-pregnancy/

  Cholestasis of pregnancy is a liver problem that happens when the flow of bile slows down or is blocked. Bile then builds up in the liver and enters the bloodstream. It can make the skin very itchy. Home treatment and medicine can relieve symptoms. […] Your doctor may prescribe medicine. Medicine can help reduce bile acid levels and relieve itching. Your doctor also will want to watch you and your baby closely. To keep you both as healthy as possible, your doctor may recommend an early delivery. […] Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. […] If your doctor prescribes them, use creams or pills to help with itching. […] Use calamine lotion on itchy areas. […] Avoid hot showers or baths. Hot water can make itching worse. […] After bathing, pat excess water off your skin. Then apply moisturizer before your skin dries completely. […] Try keeping your moisturizer in the refrigerator. It may feel better on your skin.

• #128 Cholestasis of Pregnancy Information & Treatment

  https://www.columbiadoctors.org/health-library/condition/cholestasis-pregnancy/

  Cholestasis of pregnancy is a liver problem that happens when the flow of bile slows down or is blocked. Bile then builds up in the liver and enters the bloodstream. It can make the skin very itchy. Home treatment and medicine can relieve symptoms. […] Your doctor may prescribe medicine. Medicine can help reduce bile acid levels and relieve itching. Your doctor also will want to watch you and your baby closely. To keep you both as healthy as possible, your doctor may recommend an early delivery. […] Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. […] If your doctor prescribes them, use creams or pills to help with itching. […] Use calamine lotion on itchy areas. […] Avoid hot showers or baths. Hot water can make itching worse. […] After bathing, pat excess water off your skin. Then apply moisturizer before your skin dries completely. […] Try keeping your moisturizer in the refrigerator. It may feel better on your skin.

• #129 Intrahepatic cholestasis of pregnancy | RCOG

  https://www.rcog.org.uk/for-the-public/browse-our-patient-information/intrahepatic-cholestasis-of-pregnancy/

  ICP is a condition that affects how your liver works when you are pregnant. It is sometimes called obstetric cholestasis. […] Your ICP will be monitored with regular blood tests to check your liver function and the levels of bile acids in your blood. […] Once you have been diagnosed with ICP, you should be under the care of an obstetrician. Your blood tests will usually be repeated after one week and an individualised plan of care will be made for you depending on your circumstances. […] Treatments to improve your itching are of limited benefit but might include: Skin creams such as aqueous cream, with or without the addition of menthol; Antihistamines, which may help you sleep at night; Some women have found that having cool baths and wearing loose-fitting cotton clothing helps to reduce the itching.

• #130

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=tw12250

  Cholestasis of pregnancy is a liver condition. […] Cholestasis of pregnancy can cause pregnancy complications. You have a higher chance of: […] Your healthcare provider will want to watch you and your baby more closely, usually with non-stress tests and ultrasounds. […] Follow-up care is a key part of your treatment and safety. […] Be sure to make and go to all appointments, and call your healthcare provider or nurse advice line if you are having problems. […] If your healthcare provider prescribes them, use creams or pills to help with itching. […] Watch for signs of preterm labour. […] Talk to your healthcare provider about how you’re feeling and any concerns you have. […] Call your healthcare provider, midwife, or nurse call line now or seek immediate medical care if: […] Watch closely for changes in your health, and be sure to contact your healthcare provider, midwife, or nurse call line if you have any questions or concerns.

• #131 Intrahepatic Cholestasis of Pregnancy: New Insights on an Old Issue – Women’s Healthcare

  https://www.npwomenshealthcare.com/intrahepatic-cholestasis-of-pregnancy-new-insights-on-an-old-issue/

  The efficacy of fetal monitoring to predict or reduce the risk of stillbirth related to ICP is unknown. […] The Society of Maternal-Fetal Medicine recommends initiating antepartum surveillance at a gestational age when delivery would be performed in response to abnormal results (SMFM grade 2C). […] Patients can be reassured that ICP typically resolves spontaneously shortly after delivery and that breastfeeding is not contraindicated. […] Individuals diagnosed with ICP should be counseled on the likelihood of recurrence in subsequent pregnancies, which has been estimated to be up to 90%. […] The sometimes unrelenting and intense pruritis associated with ICP can cause significant distress. Although these symptoms can often be managed, the anxiety surrounding the diagnosis can be more difficult to control. […] Thorough patient counseling and shared decision making regarding patient referral, antenatal surveillance, and delivery planning is imperative for optimal outcomes and can lessen patient anxiety when ICP is diagnosed.

• #132 Intrahepatic cholestasis of pregnancy | March of Dimes

  https://www.marchofdimes.org/find-support/topics/pregnancy/intrahepatic-cholestasis-pregnancy

  Talk to your provider about treatment for ICP. Your provider may give you prescription medicine called ursodiol (brand names Actigall and Urso). […] If you have ICP, your provider may recommend inducing labor to help prevent complications like stillbirth. Inducing labor is when your provider gives you medicine or breaks your water (amniotic sac) to make your labor begin. […] Itching should stop within a few days of giving birth. Your provider may recommend blood tests after giving birth to check your bile acid levels and make sure your liver is working well.

• #133 Cholestasis of Pregnancy: Care Instructions | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.cholestasis-of-pregnancy-care-instructions.tw12250

  Call your doctor now or seek immediate medical care if: Your itching gets worse or you get other symptoms. You think that you are in labor. There is a new or increasing yellow color to your skin or the whites of your eyes. You notice that your baby has stopped moving or is moving less than normal. Watch closely for changes in your health, and be sure to contact your doctor if you have any questions or concerns.

• #134 Cholestasis of Pregnancy: Care Instructions | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.cholestasis-of-pregnancy-care-instructions.tw12250

  Call your doctor now or seek immediate medical care if: Your itching gets worse or you get other symptoms. You think that you are in labor. There is a new or increasing yellow color to your skin or the whites of your eyes. You notice that your baby has stopped moving or is moving less than normal. Watch closely for changes in your health, and be sure to contact your doctor if you have any questions or concerns.

• #135

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=tw12250

  Cholestasis of pregnancy is a liver condition. […] Cholestasis of pregnancy can cause pregnancy complications. You have a higher chance of: […] Your healthcare provider will want to watch you and your baby more closely, usually with non-stress tests and ultrasounds. […] Follow-up care is a key part of your treatment and safety. […] Be sure to make and go to all appointments, and call your healthcare provider or nurse advice line if you are having problems. […] If your healthcare provider prescribes them, use creams or pills to help with itching. […] Watch for signs of preterm labour. […] Talk to your healthcare provider about how you’re feeling and any concerns you have. […] Call your healthcare provider, midwife, or nurse call line now or seek immediate medical care if: […] Watch closely for changes in your health, and be sure to contact your healthcare provider, midwife, or nurse call line if you have any questions or concerns.

• #136 Cholestasis of Pregnancy: Care Instructions | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.cholestasis-of-pregnancy-care-instructions.tw12250

  Call your doctor now or seek immediate medical care if: Your itching gets worse or you get other symptoms. You think that you are in labor. There is a new or increasing yellow color to your skin or the whites of your eyes. You notice that your baby has stopped moving or is moving less than normal. Watch closely for changes in your health, and be sure to contact your doctor if you have any questions or concerns.

• #137 Cholestasis of Pregnancy: Care Instructions | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.cholestasis-of-pregnancy-care-instructions.tw12250

  Call your doctor now or seek immediate medical care if: Your itching gets worse or you get other symptoms. You think that you are in labor. There is a new or increasing yellow color to your skin or the whites of your eyes. You notice that your baby has stopped moving or is moving less than normal. Watch closely for changes in your health, and be sure to contact your doctor if you have any questions or concerns.

• #138 Pregnancy Intrahepatic Cholestasis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK551503/

  The management of intrahepatic cholestasis of pregnancy (ICP) must be an interprofessional team approach. Typically, whenever feasible, an interprofessional team should include an obstetrician, maternal-fetal medicine specialist (MFM), gastroenterologist, anesthetist, and the nursing team. […] A weekly biophysical profile for fetal health monitoring should take place in patients with ICP with elevated total bile acid level (over 100 micromol/L). Delivery between 36 to 37 weeks should be considered to avoid fetal complications in a patient with severely elevated total bile salt acid levels and other risk factors, as mentioned above. Once the condition gets diagnosed, the patient should be closely monitored by the nurse and obstetrician to ensure that the ICP is not worsening. A team approach to patient management is vital if one wants to improve outcomes.

• #139 Pregnancy Intrahepatic Cholestasis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK551503/

  The management of intrahepatic cholestasis of pregnancy (ICP) must be an interprofessional team approach. Typically, whenever feasible, an interprofessional team should include an obstetrician, maternal-fetal medicine specialist (MFM), gastroenterologist, anesthetist, and the nursing team. […] A weekly biophysical profile for fetal health monitoring should take place in patients with ICP with elevated total bile acid level (over 100 micromol/L). Delivery between 36 to 37 weeks should be considered to avoid fetal complications in a patient with severely elevated total bile salt acid levels and other risk factors, as mentioned above. Once the condition gets diagnosed, the patient should be closely monitored by the nurse and obstetrician to ensure that the ICP is not worsening. A team approach to patient management is vital if one wants to improve outcomes.

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