Materiały źródłowe

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

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

  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: Taking a prescription medicine called ursodiol (Actigall, Urso, Urso Forte). This medicine helps to lower the level of bile acids in your blood. Other medicines to relieve itching also may be an option. […] 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.

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

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

  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. […] 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. […] 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. […] Cholestasis of pregnancy may cause complications. You may have problems absorbing vitamin K, which increases the risk of hemorrhage (heavy internal bleeding). […] Your pregnancy care provider may deliver your baby early to decrease the risk of these complications.

• #3 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. […] Medication treatment involves a first-line, albeit off-label, treatment with a medication called ursodeoxycholic acid (Ursodiol or Actigall). […] 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. […] There are several other medications that are sometimes used to treat cases of cholestasis of pregnancy.

• #4 Pregnancy Intrahepatic Cholestasis – StatPearls – NCBI Bookshelf

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

  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. […] Ursodeoxycholic acid (UDCA) is the drug of choice for the treatment of ICP. The initial starting dose of UDCA is not well established, but it is reasonable to start at 300 mg BID and can be increased to 300 mg three times a day until delivery. Usually, maternal symptoms will alleviate in about two weeks, and the bile acid levels will decline in two to three weeks. If there is no improvement in the patient’s symptoms or bile acid levels, the dose can be titrated every week or two to a maximum dose of 21 mg/kg/day. UDCA is well tolerated by most patients; some of the common side effects are nausea, vomiting, and diarrhea. It has no detrimental impact on the fetus. The mechanism of action of ursodeoxycholic acid is unknown, but studies have shown that after treatment, a significant reduction in total serum bile acids occurs. In a meta-analysis, patients with ICP who received UDCA had better outcomes than those who received an alternative agent. Patients using UDCA had better resolution of pruritus, reduction in liver function tests, and bile acid levels, and decreased incidence of premature birth, fetal distress, respiratory distress syndrome, and need for neonatal intensive care unit admission.

• #5 Intrahepatic cholestasis of pregnancy | March of Dimes

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

  Your provider treats ICP with medicine to help your liver work better and relieve itching. Treatment also can help reduce your risk for stillbirth. […] Talk to your provider about treatment for ICP. Your provider may give you prescription medicine called ursodiol (brand names Actigall and Urso). A prescription is an order for medicine given by a health care provider. Ursodiol helps lower the amount of bile acids in your blood, relieves itchy skin and may help reduce your baby’s risk of having complications caused by ICP. […] 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. The American College of Obstetricians and Gynecologists (ACOG) suggests women may need to have their baby before 37 weeks and 7 days of pregnancy. If your baby needs to be delivered before 39 weeks, ask your provider about the type of care your baby may need.

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

  https://mylofamily.com/article/obstetric-cholestasis-causes-symptoms-treatment-25568?srsltid=AfmBOop8ytb6rnKs21iq-d7rtCqc0rCDDSEwyrWnPbbJDC1JHy-XywrO

  Treatment is not necessary if the condition is mild. Post pregnancy, obstetric cholestasis will disappear on its own. And if you ever have to treat it, it is just to deal with the itchiness caused and you must find ways to improve your liver health in order to avoid piling up of bile. […] Take some medications as prescribed by your doctor […] Have a bath and apply coconut oil to the affected areas […] Soak your itching spots in lukewarm water and dab with baking soda […] Apple cider vinegar is also an effective remedy for itchiness […] When it comes to intake of food, focus on those that can build your liver strength […] Increase your intake of vitamin K to avoid hemorrhage […] Undergo a non-stress test to check your baby’s health […] Test your blood regularly to check the bile fluid levels

• #7 Intrahepatic Cholestasis of Pregnancy Medication: Gallstone Solubilizing Agents, Antihistamines, 1st Generation

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

  Many pharmacological agents have been used in the treatment of intrahepatic cholestasis of pregnancy (ICP). These include phenobarbital (100 mg qd), hydroxyzine (25-50 mg qd), glutathione precursor S-adenosyl methionine (SAME) (800 mg qd IV or 1600 mg qd orally), cholestyramine (8-16 g/d) and dexamethasone (12 mg 4 times daily for 7 days followed by a tapering dose). All these agents showed some limited clinical benefit (eg, phenobarbital relieved pruritus in 50% of patients but showed no reduction of liver enzymes or bile salts) but also had significant adverse effects. Vitamin K deficiency was observed with the use of cholestyramine in high doses. Dexamethasone demonstrated limited benefits in cases of ICP with significant side effects. […] Ursodeoxycholic acid (UDCA) improves clinical symptoms and liver parameters in a number of cholestatic liver disorders. The mechanism of UDCA is unknown. One putative action of UDCA is that the drug inserts a key translocator or transporter protein, improving bile salt export from the liver and theoretically reducing the risk to the fetus.

• #8 Intrahepatic Cholestasis of Pregnancy Medication: Gallstone Solubilizing Agents, Antihistamines, 1st Generation

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

  UDCA remains the drug of choice for the treatment of ICP. UDCA at a daily dose ranging from 600-2000 mg was effective at reducing pruritus, decreasing the total serum bile acid levels, ALT values, and bilirubin levels and allowing delivery closer to term (37.8 0.9 wk vs 33.8 7.1 wk). UDCA also improved the cholic acid/chenodeoxycholic acid ratio seen in ICP. UDCA has no significant maternal adverse effects. An infant follow-up study of 26 children over a 12-year period showed no long-term sequelae. Based on a meta-analysis, UDCA is effective in reducing pruritus and improving liver test results in patients with ICP, and may also improve fetal outcomes. […] While UDCA remains the treatment of choice for many, studies have called into question its effectiveness, suggesting that although it may help address symptoms in mild cases, it does not decrease adverse prenatal outcomes. Researchers suggest the need for studies using novel agents. Liu et al described the use of rifampin in a severe refractory case but also noted that while it relieved the severe symptoms, the fetus still needed to be delivered at 31 weeks due to fetal compromise. Chinese guidelines mention SAME as a possible second-line agent.

• #9 Intrahepatic Cholestasis of Pregnancy

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

  Intrahepatic Cholestasis of Pregnancy (ICP) is a liver disorder which occurs during pregnancy. […] 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. […] For bile acids greater than 100 mol/L, delivery is at 36 0/7 weeks. There is consideration for earlier delivery in these cases with other factors. For levels under 100 mol/L, delivery is recommended at 36 0/7-39 0/7 weeks with delivery earlier in the window if levels reach 40 mol/L.

• #10 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. […] Ursodeoxycholic acid is first-line treatment. […] 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. Ursodeoxycholic acid works in several ways. It increases bile acid secretion and stabilizes the plasma membrane, allowing the placenta to more effectively transfer bile acids from the fetus, and protects liver cells from the toxic effects of bile acids. […] It is first-line treatment for maternal pruritis and improvement of laboratory values (SMFM grade 1A recommendation).

• #10 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/

  Although not rigorously studied, S-adenosyl-methionine and cholestyramine are alternative treatment options. Antihistamines like diphenhydramine and hydroxyzine may also help alleviate pruritis. […] Timing of delivery is based on risk stratification guided by serum bile acid concentration and patient presentation. […] Pregnant individuals with total bile acid levels of 100 mol/L or greater should give birth at 36 0/7 weeks (SMFM grade 1B recommendation). […] Algorithm: Maternal pruritisStrategic consideration of the balance between neonatal mortality and morbidity associated with early birth and the risk of stillbirth should be weighed and discussed using shared decision making. […] 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%.

• #11 Cholestasis of pregnancy (jaundice of pregnancy, obstetric cholestasis, and prurigo gravidarum) – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/cholestasis-of-pregnancy-jaundice-of-pregnancy-obstetric-cholestasis-and-prurigo-gravidarum/

  Ursodeoxycholic acid (USDO) has been shown to control symptoms of ICP and reduce the risk of adverse fetal outcomes. As a result, this is the drug of choice. The recommended dose is 14-16mg/kg/day (450-1200mg) daily. […] Cholestyramine and phenobarbitol have been reported to be beneficial for modest elevations of bile acids, although their benefit is disputed. Cholestyramine can bring a 70% response rate but is slow acting and can precipitate vitamin K. A total of 8 to 16g/day in 3-4 divided doses is often helpful in relieving pruritus. It is most effective if started as soon as the pruritus is noted, before it becomes severe. It often takes up to 2 weeks to work. […] Phenobarbital at 100mg daily given at bedtime has shown some benefit for ICP. Phenobarbital induces hepatic microsomal enzymes, increasing bile salt secretion and bile flow. This medication usually takes more than 1 week to be effective. It has not been shown to change the serum concentration of bile acids.

• #12 SMFM Recommendations: Intrahepatic Cholestasis of Pregnancy – The ObG Project

  https://www.obgproject.com/2020/12/26/smfm-recommendations-intrahepatic-cholestasis-of-pregnancy/

  SMFM has released a Consult Series entry on Intrahepatic Cholestasis of Pregnancy (ICP), that typically presents in the second and third trimester of pregnancy. […] Describe the SMFM recommendations for monitoring and treatment of women with Intrahepatic Cholestasis of Pregnancy. […] First line: Ursodeoxycholic acid (UDCA) […] Effective first line treatment | Pruritus should decrease within 2 weeks. […] UDCA is first line for the treatment of maternal symptoms but data has not demonstrated impact on adverse neonatal outcomes. […] Delivery timing depends on bile acids levels and maternal symptoms.

• #13 Pregnancy Intrahepatic Cholestasis – StatPearls – NCBI Bookshelf

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

  For patients with no improvement of ICP, refractory to UDCA, other medications such as rifampin, cholestyramine, and S-adenosyl-L-methionine are options. Rifampin increases bile acid detoxification and excretion and can be an adjunct to ursodeoxycholic acid. Cholestyramine is an anion exchange resin that decreases the ileal absorption of bile salts, thereby increasing their fecal excretion. S-adenosyl-L-methionine is often administered using a twice-daily intravenous regimen, making it a less attractive option in the management of intrahepatic cholestasis of pregnancy. One study found UDCA more effective than S-adenosyl-L-methionine at improving liver function tests but equally effective at improving pruritus. An antihistamine such as chlorpheniramine is often used in ICP to alleviate pruritis. Antihistamines do not affect serum bile acids but may reduce the sensation of pruritus in some women.

• #14 Obstetric Cholestasis: Causes, Symptoms, and Treatment

  https://patient.info/pregnancy/pregnancy-complications/obstetric-cholestasis

  Obstetric cholestasis is a rare condition. It only affects pregnant women. In the UK fewer than 1 in 100 pregnant women will develop it. […] What is the treatment for obstetric cholestasis? […] Ursodeoxycholic acid may be used to treat obstetric cholestasis. This is used to lower the amount of bile acids in the blood. This has been shown to decrease the itching and also to decrease the risks of pre-term birth, distress of the baby during delivery, respiratory distress after birth and need for the baby to be admitted to a neonatal intensive care unit. […] Sometimes a medication called rifampicin is used alongside ursodeoxycholic acid. […] Treatment with ursodeoxycholic acid may resolve the symptoms of itching.

• #15 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Treatment-of-intrahepatic-cholestasis-of-pregnancy-(ICP).aspx

  The baby is regularly monitored by ultrasound scans for growth and also for development of complications. Cardiotocography is used to monitor the fetal heart health. […] Creams and soothing lotions are prescribed for the mother to control the itching. These are safe for both mother and baby but their efficacy is not clearly evidenced. […] Some women may be prescribed anti-itching medications called anti-histaminic medications like Chlorpheniramine. These relieve itching and also allow sleeping as they have sedative effects. […] Medication therapy includes a drug called Ursodeoxycholic acid (USDA). This can reduce itchiness, improve the function of the liver and reduce the risks to the baby. It leads to side effects like diarrhea. […] Cholestyramine has been proven to reduce itching in some women but may lead to further vitamin K deficiency.

• #15 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Treatment-of-intrahepatic-cholestasis-of-pregnancy-(ICP).aspx

  Intrahepatic cholestasis of pregnancy (ICP or obstetric cholestasis) may be mild and harmless but in severe cases may cause damage to the fetus. This is the reason why it needs to be treated appropriately and adequately. […] The most important part of management of ICP includes regular monitoring of the pregnant woman for increasing bile acids in blood that could harm the baby. […] General management of intrahepatic hepatic cholestasis of pregnancy includes regular liver function tests, fetal monitoring and so forth. […] Pregnant women with suspected ICP need to visit their doctors (antenatal visits) in every one or two weeks to monitor the progress of their pregnancy. […] Liver function tests should be monitored weekly. If they return to normal or rise excessively, the diagnosis needs to be revised.

• #16

  https://journals.lww.com/mfm/fulltext/2024/01000/clinical_management_guidelines_for_intrahepatic.4.aspx

  Intrahepatic cholestasis of pregnancy (ICP) is a significant gestational complication in late pregnancy, potentially leading to severe perinatal complications such as intrauterine fetal demise and preterm birth. […] The authors would like to apologize for any inconvenience caused. […] The goals of pharmacological treatment for ICP are to improve perinatal outcomes, reduce perinatal mortality, and complications and to alleviate maternal pruritus symptoms. For many years, UDCA has been recommended as the first-choice drug for treating ICP. […] This guideline still recommends UDCA as the first-line drug for ICP treatment, and more high-quality clinical research is needed to confirm this. […] S-adenosyl-methionine (SAMe), a glutathione precursor, has also been considered as a treatment for ICP.

• #17

  https://journals.lww.com/mfm/fulltext/2024/01000/clinical_management_guidelines_for_intrahepatic.4.aspx

  This consensus continues to follow the previous guideline recommendations, suggesting SAMe as a second-line treatment or combination therapy. […] The timing of pregnancy termination in ICP should be based on the patients risk level, including factors, such as maternal serum TBA levels, gestational age, obstetric history, ICP history, and stillbirth history; prenatal test results; and gestational age at onset of symptoms. […] For severe ICP, termination of pregnancy is recommended at 36-38 weeks of gestation. […] Intrahepatic cholestasis of pregnancy is not an indication for cesarean section. It is suggested to plan for induced labor and termination of pregnancy via vaginal birth. […] After delivery in ICP, maternal serum TBA concentration and liver function indicators should be assessed to determine whether pruritic symptoms and laboratory indicators have normalized.

• #18 Itching and intrahepatic cholestasis of pregnancy – NHS

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

  Intrahepatic cholestasis of pregnancy (ICP) is a potentially serious liver disorder that can develop in pregnancy. […] There’s no cure for ICP, but it should go once you’ve had your baby. […] If you have ICP, you will probably be advised to give birth in hospital under a consultant-led maternity team. […] ICP is diagnosed by excluding other causes of the itch. […] 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. […] A possible alternative, which can be helpful if itchiness is keeping you awake at night, is antihistamine medicine, such as chlorphenamine. […] You may also be offered a vitamin K supplement. […] If you are diagnosed with ICP, your midwife and doctor will discuss your health and your options with you. […] There is information about obstetric cholestasis on the Royal College of Obstetricians Gynaecologists (RCOG) website, including what it means for you and your baby, and the treatment that’s available.

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

  https://americanpregnancy.org/healthy-pregnancy/pregnancy-complications/cholestasis-of-pregnancy/

  Cholestasis of Pregnancy: Causes, Symptoms & Treatment […] 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: […] Medication to decrease the concentration of bile acids such as ursodeoxycholic acid […] 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) […] Treatment for cholestasis of pregnancy needs to be determined by your physician, who will take the following criteria into consideration: […] Treatments that should not be used for cholestasis include: […] There are conflicting views on using the medication Cholestyramine for the treatment of cholestasis. In the past, this medication was readily used to treat this condition, but some studies have shown that Cholestyramine may not be as effective as other treatments and potentially has some adverse side effects such as blocking essential vitamins like Vitamin K (a vitamin that is already deficient in women with cholestasis).

• #20 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Treatment-of-intrahepatic-cholestasis-of-pregnancy-(ICP).aspx

  All mothers and babies need to be supplemented with Vitamin K. Mothers need it if they develop jaundice and pale chalky white stools and a deranged blood coagulation profile (increased prothrombin time). […] Timing of delivery may have to be carefully decided. The timing aims to reduce the risk of stillbirths. This is done by monitoring the baby closely and look for signs of distress and changes in the heart functions and lung maturity. […] In these cases the delivery or labor may be induced or sped up. Chances of maternal or fetal deaths are common after 37 weeks of pregnancy. Labor should be induced beyond this time. […] Some women in whom labor cannot be induced a caesarean section is considered. […] After birth of the baby the LFT usually returns to normal. If it does not, then other diagnosis must be suspected and excluded.

• #21 TREATMENT OF INTRAHEPATIC CHOLESTASIS OF PREGNANCY (OBSTETRIC CHOLESTASIS) – UKTIS

  https://uktis.org/monographs/treatment-of-intrahepatic-cholestasis-of-pregnancy-obstetric-cholestasis/

  A corresponding patient information leaflet on TREATMENT OF INTRAHEPATIC CHOLESTASIS OF PREGNANCY (OBSTETRIC CHOLESTASIS) is available. […] Symptomatic treatments to reduce the sensation of itch include topical emollients (with or without menthol) and sedating antihistamines. The most widely used pharmacological treatment to treat ICP is ursodeoxycholic acid (UDCA); however, the Royal College of Obstetricians and Gynaecologists (RCOG) guidelines (produced in 2022) do not recommend routine use of UDCA for the purpose of reducing adverse perinatal outcomes in women with ICP. Rifampicin is occasionally used on a case-by-case basis as an adjunct to UDCA in women with severe ICP who are not responding to UDCA alone. […] The RCOG guidelines recommend maternal vitamin K supplementation only if there appears to be reduced absorption of dietary fats and/or evidence of abnormal prothrombin time.

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

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

  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. […] The past consensus has been that ICP is a contraindication for OCP use. However, some authors suggest that the newer low-dose pills can be safely used as long as liver function test results are followed and patients are aware of possible recurrence risks. […] If bile acid levels remain elevated at 6 months postpartum, further evaluation is indicated to rule out an underlying genetic disorder or chronic liver disease.

• #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. […] One study demonstrated that increased fetal testing and scheduled induction with documentation of fetal lung maturity in patients with ICP lessened perinatal mortality rates compared with patients who were not tested. […] 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. […] 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.

• #23 Intrahepatic cholestasis of pregnancy | RCOG

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

  When your baby is born your ICP will get better. […] 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. […] There is a medication called ursodeoxycholic acid, which may slightly reduce itching in a small number of women. […] There is no treatment available that helps your baby or that will make your bile acid levels better. […] 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. […] If you are having one baby and your pregnancy has had no other complications, the following recommendations apply to you: Planned birth at 38-39 weeks gestation may be recommended if your bile acid levels are 40-99 micromol/L and if you have no other risk factors.

• #23 Intrahepatic cholestasis of pregnancy | RCOG

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

  A plan will be made for monitoring your baby’s heartbeat in labour depending on your circumstances and preferences. […] ICP symptoms get better after birth. […] If you still have symptoms or if your blood tests have not returned to normal by this time, you may be referred to a specialist for further investigations.

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

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

  These medications include Cholestyramine, S-Adenosyl-L-methionine (SAMe), Rifampin and Vitamin K. […] A recent study in 2019 on over 5000 cholestasis pregnancies determined stillbirth risk based upon bile acid levels. […] The two main governing boards in the United States (SMFM – Society of Maternal Fetal Medicine and ACOG – American College of Obstetricians and Gynecologists) are in agreement regarding recommendations for delivery timing. […] Steroid management: Betamethasone is a steroid medication that can be given in a pregnancy to help prevent complications of prematurity in the fetus and aid with lung maturity.

• #25 Self Help for Intrahepatic Cholestasis of Pregnancy (ICP) – ICP Care

  https://icpcare.org/managing-symptoms/self-help/

  Self Help for Intrahepatic Cholestasis of Pregnancy (ICP) […] While there is no cure for Intrahepatic Cholestasis of Pregnancy, there are many ways to manage and ease symptoms of the disorder, which is better for mother and baby. Eating a healthy diet and lowering stress levels is best for women with or without ICP. Please note the information on this page are self-help tips that women with (ICP) Intrahepatic Cholestasis of Pregnancy found helpful. […] Ask Your Health Care provider about Recommended medications […] Ursodeoxycholic Acid (Ursodiol) is the first line treatment. It may help with itching and is shown to prevent some complications. […] Vistaril – Hydroxyzine – can be used to treat symptoms such as itching. […] Antihistamines and Lotions […] Antihistamines are medicines used to treat allergies and hypersensitive reactions. There is no evidence to prove that antihistamines such as Benedryl help in ICP, and many women with ICP do not receive much relief from itching when taken. There are lotions such as Sarna which have a cooling effect on the skin and may provide temporary relief. Sarna lotion is a menthol lotion many itchymoms find soothing. It does not reduce the bile acids and is not a treatment, but rather a topical help for the itching. Many women find that rubbing the Sarna lotion and then sitting in front of a fan helps to cool and soothe. You may also try other options like Aveeno and Grandpa’s Pine Tar Soap. You can speak to your pharmacist to make an aqueous cream with 1-2% menthol. In the UK, there is a product called Dermacool to temporarily help relieve the itch.

• #26 Intrahepatic cholestasis of pregnancy – British Liver Trust

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

  Several antihistamines are safe to take if you are pregnant. Some people find that they help with itching and some antihistamines can help you to sleep by making you drowsy. […] You might also hear this called urso or UDCA. […] Aqueous cream with menthol can sometimes provide some relief. […] Emollient creams and ointments can sometimes help with itching. You can ask your local pharmacist to suggest which to try. […] Having a cool bath or placing a cool, wet cloth on the itching area can help to reduce itching. […] Try to avoid tight clothes or clothes made from wool or synthetic fabrics. […] Keep your nails clean, short and smooth to reduce the damage to your skin if you scratch. […] There is no evidence that any foods will help with ICP or make it worse. It is best to try and eat a healthy balanced diet.

• #27 Intrahepatic cholestasis of pregnancy (ICP)

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

  Moisturising skin creams, particularly those containing menthol, may reduce the feeling of itching in some women and are safe to use in pregnancy. […] Antihistamines that cause drowsiness are sometimes prescribed to help women with ICP sleep if they are experiencing itching. The antihistamines chlorphenamine and promethazine are widely used in pregnancy and are not known to harm the baby. […] Ursodeoxycholic acid (UDCA), or urso is sometimes used in women with ICP. UDCA can reduce bile acid levels. UCDA is not known to be harmful in pregnancy, and while it helps some women with itching, there is no strong proof that it reduces the chance of other ICP-related problems. […] Rifampicin is occasionally prescribed alongside UCDA if a womans bile acid levels are high. Taking rifampicin is not known to be harmful in pregnancy; however, only a small number of studies have investigated its use in pregnant women. Ongoing research is therefore required. Rifampicin can reduce vitamin K levels, so when it is used, it is recommended that vitamin K is given to the baby after delivery.

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

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

  Yes, just because you have cholestasis during pregnancy doesnt mean your baby will be unhealthy. […] You cant prevent cholestasis of pregnancy. Genetic testing may help you understand the chance of passing this disorder on to your child. […] Cholestasis of pregnancy goes away a few days after your baby is born. Your bile levels return to normal after delivery. You can stop taking medication once your levels return to typical levels.

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

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

  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. […] The good news is if youve had it before, youre equipped with that knowledge. 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. Your doctor will give you the sign to stop taking your medication if youve been taking ursodeoxycholic acid to keep those bile levels in check.

• #30

• #31 Intrahepatic cholestasis of pregnancy – British Liver Trust

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

  If your test results are normal, this will confirm that your itching was caused by ICP. You will not need any further treatment. […] If your test results are not normal, there could be something else going on with your liver. You might need to have more tests. Or be referred to a hepatology or gastroenterology department so that they can find out more.

• #32 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Treatment-of-intrahepatic-cholestasis-of-pregnancy-(ICP).aspx

  All women need to be counselled that there is a 60 to 90% risk of recurrence of the condition in subsequent pregnancies. […] Women with obstetric cholestasis cannot take oral contraceptive pills for contraception after the birth of their babies. These pills often cause liver damage in such women. […] Each case has to be decided on an individual basis, based on risks and benefits. Alternative methods of contraception are discussed. […] Obstetric cholestasis is usually not worsened by alcohol intake. However, pregnant women should avoid drinking alcohol to prevent harm to their baby.

• #33 Intrahepatic Cholestasis of Pregnancy (ICP) | Tommy’sCloseleft-arrowleft-arrowleft-arrowleft-arrowleft-arrowleft-arrowCloseReconfirm cookies choice

  https://www.tommys.org/pregnancy-information/pregnancy-complications/obstetric-cholestasis

  Depending on your bile acid levels and other risk factors like pre-eclampsia, they may ask you to consider having a planned birth, either by having your labour induced or by c-section. This is to reduce the chance of your baby being stillborn. […] Will having ICP affect me after I’ve had my baby? […] Previously having ICP does not affect your choice of contraception once your liver blood tests and bile acid levels are normal again. […] Having ICP increases your chance of having it again in future pregnancies. […] There is some evidence that people with ICP may be slightly more likely to have liver problems in the future, or other conditions including psoriasis, thyroid disease, heart disease and Crohn’s disease. But extra screening or follow-up is not recommended.

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

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

  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. These include progestin-containing contraceptives, intrauterine devices (IUDs) or barrier methods, such as condoms or diaphragms. […] Research into effective alternative therapies for treating cholestasis of pregnancy is lacking, so pregnancy care providers generally don’t recommend them for this condition. […] The safety of other alternative therapies hasn’t been confirmed. Always check with your health care provider before trying an alternative therapy, especially if you’re pregnant.

• #35 Still in Search of an Effective Treatment for Intrahepatic Cholestasis of Pregnancylogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na49675/2019/08/19/still-search-effective-treatment-intrahepatic-cholestasis

  Still in Search of an Effective Treatment for Intrahepatic Cholestasis of Pregnancy […] Compared with placebo, ursodeoxycholic acid modestly improved pruritis but did not reduce adverse perinatal outcomes. […] Ursodeoxycholic acid reduced pruritis by 13% (P<0.005) and increased serum bile acid concentration by 21% (P<0.03). [...] This trial demonstrates that, in the setting of intrahepatic cholestasis of pregnancy, ursodeoxycholic acid's therapeutic effect is limited to a modest reduction in pruritis with no other major benefits. [...] To reduce risk for intrauterine fetal demise, the American College of Obstetricians and Gynecologists recommends that women with ICP be delivered between 36 and 37 weeks' gestation (or at ICP diagnosis if detected after 37 weeks).

• #36 Interventions for treating intrahepatic cholestasis of pregnancy (ICP) | Cochrane

  https://www.cochrane.org/CD000493/PREG_interventions-treating-intrahepatic-cholestasis-pregnancy-icp

  We searched for evidence in December 2019, and identified 26 trials involving 2007 women. The trials assessed nine different interventions, but for most of them the trials were small and had a high risk of bias; we were therefore unable to draw firm conclusions. However, the most widely-used treatment, ursodeoxycholic acid (UDCA), for which we identified seven trials (1008 women), included two trials at low risk of bias (755 women). There is now evidence that UDCA probably reduces itching (moderate-certainty evidence). However, the size of the effect is small and for many pregnant women may not be worthwhile. The evidence for an effect of UCDA on stillbirth or fetal distress is unclear, mainly due to limitations in study design and imprecise results (very low-certainty evidence). […] When compared with placebo, UDCA administered to women with ICP probably shows a reduction in pruritus. However the size of the effect is small and for most pregnant women and clinicians, the reduction may fall below the minimum clinically worthwhile effect. The evidence was unclear for other adverse fetal outcomes, due to very low-certainty evidence. There is insufficient evidence to indicate that SAMe, guar gum, activated charcoal, dexamethasone, cholestyramine, YCHD, DXLP, Salvia, Yiganling alone or in combination are effective in treating women with cholestasis of pregnancy.

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

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

  Intrahepatic cholestasis of pregnancy (ICP) is a liver condition that can happen during the second and third trimesters of pregnancy. […] ICP is diagnosed with a blood test that confirms increased levels of bile acids. […] What is the treatment for ICP? 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. […] A corticosteroid medication can help the fetal organs mature if delivery is planned for earlier than 37 weeks. […] Management includes medication, antenatal testing, and early delivery.

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