Materiały źródłowe

• #1 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. Cholestasis of pregnancy typically goes away after your baby is born. […] 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 doesn’t harm you or the fetus. […] If medication doesn’t 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. […] Your pregnancy care provider may deliver your baby early to decrease the risk of these complications. […] You can’t prevent cholestasis of pregnancy. Genetic testing may help you understand the chance of passing this disorder on to your child. […] You’re at higher risk for developing cholestasis of pregnancy if you have a family member with the condition. […] Cholestasis of pregnancy goes away a few days after your baby is born. Your bile levels return to normal after delivery.

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

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

  There is no known way to prevent cholestasis of pregnancy.

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

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

  The recurrence rate for ICP is believed to be 45-70%. In patients with a history of ICP, oral contraceptives containing estrogen should be used with caution and at the lowest possible dose. Exogenous estrogen in these patients can lead to cholestasis outside of pregnancy. Conversely, patients who exhibit cholestasis with the use of OCPs should be evaluated for ICP during pregnancy. […] For all patients with ICP, serum bile acid levels and liver function tests should be drawn 3-6 months postpartum. 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. There is no data about the advisability of monitoring patients with a history of ICP during subsequent pregnancies. As recurrence rates are high for ICP, especially those with a genetic predisposition, the authors recommend a baseline bile acid level and liver enzymes and repeat levels if symptoms occur. 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.

• #1

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

  We recommend that clinicians screen for high-risk factors of ICP, especially in high-prevalence areas; provide adequate prenatal education, prenatal care and assessment, monitor for abnormal blood pressure, blood glucose, and weight gain during pregnancy; and promptly identify and control high-risk factors (strong recommendation, moderate-level evidence). […] If pregnant women in mid-to-late pregnancy present with pruritus, associated scratch marks, jaundice, or gastrointestinal symptoms, we recommend that clinicians pay attention to these symptoms and screen for ICP in these women (strong recommendation, high level of evidence). […] The risk of stillbirth and preterm birth is related to the level of TBA. When maternal TBA level is 100 mol//L, the risk of stillbirth and preterm birth is significantly increased (strong recommendation, moderate level of evidence).

• #1 Cholestasis of Pregnancy: A Must-Know Guide for Moms-to-Be

  https://www.nawcare.com/blog/cholestasis-of-pregnancy

  Cholestasis of pregnancy, or intrahepatic cholestasis of pregnancy, is a liver disorder that stops or slows the flow of bile from the liver, causing intense itching, yellowing of the skin and eyes (jaundice), and an increased risk of stillbirth. […] Therefore, pregnant women need to be aware of the symptoms and causes of ICP to act on time. […] You may have an increased risk of ICP if you: […] Schedule regular prenatal check-ups to monitor liver function and detect the condition early. […] Get tested as soon as you experience severe itching.

• #1 ICP (Intrahepatic Cholestasis of Pregnancy) | PUSH Pregnancy | Stillbirth Prevention

  https://www.pushpregnancy.org/post/icp-intrahepatic-cholestasis-of-pregnancy

  The treatment of 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. […] The most important thing to know: DON’T IGNORE THE ITCH AND ALWAYS ASK YOUR PROVIDER IF YOU HAVE ANY CONCERNS!

• #1 Asymptomatic intrahepatic cholestasis of pregnancy

  https://www.oatext.com/asymptomatic-intrahepatic-cholestasis-of-pregnancy.php

  The lack of significant differences in pregnancy complication rates and baseline biochemical measurements in pregnant women with ICP with or without pruritus suggests that asymptomatic ICP is a distinct subclinical variant of ICP. […] Due to the subclinical latent course, the diagnosis of asymptomatic ICP which carries a high risk of pregnancy complications may be missed. In our study, screening of pregnant women with or without pruritus revealed a high prevalence of asymptomatic ICP that may be similar to the prevalence of classical ICP Therefore, the determination BAs serum levels may be appropriate not only in patients with clinical symptoms of ICP, but also in patients without pruritus who have increased levels of transaminases or cholestatic liver enzymes or a family history of ICP.

• #1 Cholestasis of pregnancy: Symptoms, pictures, tests, diet, and more

  https://www.medicalnewstoday.com/articles/173503

  Cholestasis of pregnancy is a liver condition that can cause severe itching, especially on the hands and feet. […] A pregnant person who has any of the signs or symptoms mentioned above should tell a healthcare professional as soon as possible, as they could indicate a risk for the health of the fetus. […] To prevent complications before they occur, a person will also need ongoing blood tests to monitor their liver function and blood bile levels. […] Doctors often recommend induced labor before 39 weeks if cholestasis is severe. […] Some believe that eating a balanced diet may help a person with cholestasis of pregnancy reduce the conditions severity, or prevent the condition. However, there is no research to support this. […] It is important to follow a doctors instructions regarding treatment and diet. Certain foods such as unpasteurized dairy should be avoided during pregnancy because they come with risks for the health of the pregnant person and fetus. Also, diet is not an alternative to medication that a doctor prescribes.

• #1 Healthy Diet – ICP Care

  https://icpcare.org/managing-symptoms/healthy-diet/

  A healthy diet during pregnancy is not only critical for your baby’s health and development, but it may help women that experience Intrahepatic Cholestasis of Pregnancy manage their symptoms. […] The American Liver Foundation recommends a pregnant woman with ICP have a pregnancy diet plan that makes it easier for the liver to do its job and can help repair some liver damage with essential nutrients. […] The Perinatal Research Group on ICP in Argentina for the Clinical Practice Guideline recommend a healthy diet as part of the treatment. Although currently there is no research into Intrahepatic Cholestasis of Pregnancy and diet there is some evidence to suggest that it may help women that experience ICP to reduce symptoms. […] Pregnant women should not replace a healthy diet with any treatment and management plan that may have been implemented by the healthcare provider. Treatments such as the medicine Ursodeoxycholic acid (UDCA or Urso) and early delivery are still necessary to follow as directed by the healthcare provider. […] Food is powerful for good health and during pregnancy even more important to have better nutrition during pregnancy. Women with Cholestasis of Pregnancy notice less itchy symptoms following a nutritious diet of real food that is whole, fresh and unprocessed.

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

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

  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. […] 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: […] 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. […] 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.

• #1 Itching and intrahepatic cholestasis of pregnancy – NHS

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

  Wearing loose clothes may help prevent itching, as your clothes are less likely to rub against your skin and cause irritation. […] You may also want to avoid synthetic materials and opt for natural ones, such as cotton, instead. These are „breathable” and allow the air to circulate close to your skin. […] Let your midwife or doctor know if you are experiencing itching so they can decide whether you need to have any further investigations. […] If you have ICP, you will probably be advised to give birth in hospital under a consultant-led maternity team. […] 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. […] You may also be offered a vitamin K supplement. This is because ICP can affect your absorption of vitamin K, which is important for healthy blood clotting. […] If you are diagnosed with ICP, your midwife and doctor will discuss your health and your options with you.

• #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. […] 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.

• #1 Cholestasis of pregnancy: Symptoms, pictures, tests, diet, and more

  https://www.medicalnewstoday.com/articles/173503

  Treatment normally aims to relieve symptoms, mainly the itching, and prevent potential complications. […] The primary treatment is ursodeoxycholic acid, which relieves itching and increases bile flow. […] People with cholestasis will have low levels of vitamin K, increasing the chance of hemorrhage, so a person will often need Vitamin K supplements before and after delivery. […] Doctors often induce labor early if the pregnant person has cholestasis of pregnancy because of the potentially serious complications for the baby.

• #1 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 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. […] 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.

• #1

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

  Ursodeoxycholic acid is the recommended first-choice drug for treating ICP. S-adenosyl-methionine may be used as a second-line drug or combination therapy for ICP treatment (weak recommendation, low evidence level). […] The timing of pregnancy termination in ICP should consider various factors such as maternal TBA levels, gestational age, obstetric history, previous ICP and stillbirth history, prenatal tests, and gestational age at onset of symptoms (strong recommendation, low level of evidence). […] 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. If not, the patient should be referred to a hepatologist for evaluation of potential co-existing hepatobiliary disease (strong recommendation, moderate level of evidence).

• #1 Intrahepatic Cholestasis in Pregnancy: Review of the Literature

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7290322/

  Intrahepatic cholestasis of pregnancy (ICP) is the most common hepatic disorder related to pregnancy in women. […] Therapeutic management is aimed at reducing the clinical symptoms, normalizing maternal biochemistry and preventing complications to the fetus. […] Pharmacological treatment of intrahepatic cholestasis of pregnancy consists of the administration of ursodeoxycholic acid to lower the levels of TBA and possibly reduce pruritus. […] If the treatment fails, premature delivery should be considered. […] Patients should follow a light and low-fat diet. […] Administration of ursodeoxycholic acid (UDCA) is the treatment of choice. […] In ICP-complicated pregnancies, the practice at numerous centers consists of artificial induction of labor at the 37th or 38th week of gestation.

• #1 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 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). […] Timing of delivery is based on risk stratification guided by serum bile acid concentration and patient presentation. […] 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%.

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

  https://mylofamily.com/article/obstetric-cholestasis-causes-symptoms-treatment-25568?srsltid=AfmBOorDXu6mEP6_jy6z0sapujhwEJM_vt3TN3PJcx7dxHy0Wz1F57Rh

  In order to avoid complications and prevent cholestasis of pregnancy: […] Undergo frequent ultrasound scans to monitor the babys health […] Regular blood tests to ensure the levels of bile fluids and liver functions are safe […] Measurement of fetal heartbeats according to the movements […] Non-stress test to monitor the babys movement.

• #1 Intrahepatic Cholestasis of Pregnancy (On-demand CE)

  https://www.hivece.com/courses/icp

  Intrahepatic Cholestasis of Pregnancy (ICP) is a complex liver disease which typically presents in the third trimester of pregnancy. […] This course reviews the evidence for the best approach to risk-based management, and provides a plan for holistic preventative support of at-risk clients as well as the holistic treatment of clients with mild ICP in an out-of-hospital setting. […] 2.3 A New Protocol: Holistic Prevention for ICP Recurrence […] I love having this holistic protocol in my arsenal! We have managed a few ICP cases over the years and they seem always to end up in the hospital. Love these lab value cutoffs for safety and an approach that focuses on prevention! […] Excellent. I used the protocol that was suggested for a client that had cholestasis in her prior pregnancy. And it worked! I felt so confident and informed after this class. […] This course opened a whole new set of possibilities! […] This was a fantastic training! I have used the information with a current client who had ICP with her first pregnancy and this pregnancy has been complication free and my client feels amazing!

• #1 Intrahepatic Cholestasis of Pregnancy – Dr. Shiva

  https://www.drshivahk.com/intrahepatic-cholestasis-of-pregnancy/

  Preventive Measures: While ICPs exact prevention remains elusive, maintaining a healthy lifestyle during pregnancy can potentially reduce its risk. Regular prenatal check-ups, a balanced diet, and staying hydrated are vital components of a holistic approach to maternal health. […] Managing ICP requires a team effort you, your doctor, and your support network.

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

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

  Your doctor will want to watch you and your baby closely. To keep you both as healthy as possible, your doctor may recommend an early delivery. Doctors also usually recommend medicine. Medicine can reduce bile acids. […] Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

• #1 Intrahepatic Cholestasis of Pregnancy

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

  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. […] Delivery recommendations are based on bile acid levels as risks increase as bile acids become more elevated.

• #2 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. […] This condition affects the normal flow of bile. Bile acids are chemicals in the bile of the liver that help with digestion. With ICP the bile flow begins to slow down and the bile acids build up in the blood. This results in the woman itching that can vary in severity and type. The itching can be bothersome to severe itching and is often worse at night. […] Intrahepatic Cholestasis of Pregnancy is a condition in which the normal flow of bile is affected by the increased amounts of pregnancy hormones. Cholestasis is more common in the last trimester of pregnancy when hormones are at their peak. […] 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.

• #2 Cholestasis of pregnancy – Augusta HealthSearchClose SearchSearch IconSearch IconClose Search IconMobile Menu IconMobile Menu Close IconInstagramFacebookTwitterYoutube

  https://www.augustahealth.com/disease/cholestasis-of-pregnancy/

  There is no known way to prevent cholestasis of pregnancy. […] Because complications can be very dangerous for your baby, your doctor may consider inducing labor before your due date.

• #2

  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 levels of TBA in pregnant women with ICP are closely related to adverse perinatal outcomes. Several studies have indicated that the risks of stillbirth, preterm birth, neonatal asphyxia, Acute Respiratory Distress Syndrome, and fetal cardiac dysfunction are significantly higher in pregnant women with TBA levels 40 mol/L. […] This guideline, led by the Obstetrics Group of the Gynecology and Obstetrics Branch and the Perinatal Medicine Branch of the Chinese Medical Association, aims to address related issues in diagnosing and treating ICP. […] High-risk factors for ICP revealed in published clinical studies are not entirely consistent.

• #2 EBB 120 – Cholestasis in Pregnancy with Nicole Phelps – Evidence Based Birth®

  https://evidencebasedbirth.com/ebb-120-cholestasis-in-pregnancy-with-nicole-phelps/

  Breastfeeding is not contraindicated with a diagnosis of cholestasis during pregnancy. […] Cholestasis during pregnancy affects about 1 to 2 in 1,000 pregnant people in the U.S. and about 1 in 140 pregnant people in the U.K. […] It’s estimated that the condition affects about 5% of Latina women in the U.S. and about 1% of women who have Northern European ancestry. […] The increase in the pregnancy hormones estrogen and progesterone may make some people susceptible to developing the condition. […] Studies have found increased risk of the condition among pregnant people who have had in vitro fertilization pregnancies and among those over the age of 35 years. […] Some care providers recommend planned early birth (induction) to prevent stillbirth and other complications. […] All six professional practice guidelines that were reviewed by Bicocca et al. (2018) recommend induction between 36 and 38 weeks for cholestasis during pregnancy.

• #2 Cholestasis | Pregnancy Birth and Baby

  https://www.pregnancybirthbaby.org.au/cholestasis

  Cholestasis of pregnancy is usually treated with a medicine called ursodeoxycholic acid. This lowers bile acid levels and can help relieve your itchy skin. Your doctor will prescribe the medicine if you need it. You should start taking it right away and continue taking it until after your baby is born. Your doctor and pharmacist will give you more information about how to take this medication and when its safe to stop taking it. […] Because the exact cause of cholestasis of pregnancy is unknown, there is no known way to prevent it. If you notice symptoms of itchy palms or feet, were diagnosed with cholestasis in a previous pregnancy or have a close family member who was diagnosed with it, let your healthcare team know. This may help you get a timely diagnosis and treatment if you need it.

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

  https://mylofamily.com/article/obstetric-cholestasis-causes-symptoms-treatment-25568?srsltid=AfmBOorDXu6mEP6_jy6z0sapujhwEJM_vt3TN3PJcx7dxHy0Wz1F57Rh

  In order to avoid complications and prevent cholestasis of pregnancy: […] Undergo frequent ultrasound scans to monitor the babys health […] Regular blood tests to ensure the levels of bile fluids and liver functions are safe […] Measurement of fetal heartbeats according to the movements […] Non-stress test to monitor the babys movement.

• #2 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 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). […] Timing of delivery is based on risk stratification guided by serum bile acid concentration and patient presentation. […] 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%.

• #2 Asymptomatic intrahepatic cholestasis of pregnancy

  https://www.oatext.com/asymptomatic-intrahepatic-cholestasis-of-pregnancy.php

  With the early recognition of a subclinical ICP variant, the appropriate treatment can be instituted to prevent the development of severe perinatal complications. […] Therefore, we recommend searching for ICP in women with a history of gestational complications, such as premature birth, intrauterine hypoxia, intrauterine fetal death, preeclampsia or placental insufficiency, as well as in women with such complications in the current pregnancy. […] The repeated BA determination is an appropriate option to monitor the effectiveness of treatment in asymptomatic ICP women. In view of the increased risk of fetal complications in women with ICP, pregnant women should undergo BAs screening to detect asymptomatic/ subclinical cases.

• #2 ICP (Intrahepatic Cholestasis of Pregnancy) | PUSH Pregnancy | Stillbirth Prevention

  https://www.pushpregnancy.org/post/icp-intrahepatic-cholestasis-of-pregnancy

  The treatment of 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. […] The most important thing to know: DON’T IGNORE THE ITCH AND ALWAYS ASK YOUR PROVIDER IF YOU HAVE ANY CONCERNS!

• #2 Intrahepatic Cholestasis of Pregnancy – Dr. Shiva

  https://www.drshivahk.com/intrahepatic-cholestasis-of-pregnancy/

  Preventive Measures: While ICPs exact prevention remains elusive, maintaining a healthy lifestyle during pregnancy can potentially reduce its risk. Regular prenatal check-ups, a balanced diet, and staying hydrated are vital components of a holistic approach to maternal health. […] Managing ICP requires a team effort you, your doctor, and your support network.

• #2 Intrahepatic Cholestasis in Pregnancy: Review of the Literature

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7290322/

  Intrahepatic cholestasis of pregnancy (ICP) is the most common hepatic disorder related to pregnancy in women. […] Therapeutic management is aimed at reducing the clinical symptoms, normalizing maternal biochemistry and preventing complications to the fetus. […] Pharmacological treatment of intrahepatic cholestasis of pregnancy consists of the administration of ursodeoxycholic acid to lower the levels of TBA and possibly reduce pruritus. […] If the treatment fails, premature delivery should be considered. […] Patients should follow a light and low-fat diet. […] Administration of ursodeoxycholic acid (UDCA) is the treatment of choice. […] In ICP-complicated pregnancies, the practice at numerous centers consists of artificial induction of labor at the 37th or 38th week of gestation.

• #2 Cholestasis of pregnancy: Symptoms, pictures, tests, diet, and more

  https://www.medicalnewstoday.com/articles/173503

  Cholestasis of pregnancy is a liver condition that can cause severe itching, especially on the hands and feet. […] A pregnant person who has any of the signs or symptoms mentioned above should tell a healthcare professional as soon as possible, as they could indicate a risk for the health of the fetus. […] To prevent complications before they occur, a person will also need ongoing blood tests to monitor their liver function and blood bile levels. […] Doctors often recommend induced labor before 39 weeks if cholestasis is severe. […] Some believe that eating a balanced diet may help a person with cholestasis of pregnancy reduce the conditions severity, or prevent the condition. However, there is no research to support this. […] It is important to follow a doctors instructions regarding treatment and diet. Certain foods such as unpasteurized dairy should be avoided during pregnancy because they come with risks for the health of the pregnant person and fetus. Also, diet is not an alternative to medication that a doctor prescribes.

• #2 What is cholestasis of pregnancy?

  https://www.babycenter.com/pregnancy/your-body/cholestasis-of-pregnancy_20000158

  Cholestasis of pregnancy (also known as intrahepatic cholestasis of pregnancy) affects about 1 in 1,000 pregnant women in the United States. While untreated cholestasis may lead to serious complications for your baby, monitoring and treatment helps reduce risks. […] Treatment of cholestasis typically includes taking medication to ease symptoms, taking an anti-itch medication, and getting more frequent ultrasounds and tests to make sure your baby’s doing okay. […] Cholestasis and the itchiness go away after you deliver your baby, usually within a few days, and usually doesn’t cause liver problems in the future. However, cholestasis often happens again in a subsequent pregnancy, so be sure to let your provider know that you’ve had it before. […] Call your provider right away if you think you might have cholestasis. Without treatment and monitoring, cholestasis could become dangerous for your baby. […] The risks to your baby increase with higher levels of bile acids in your blood and the closer you are to your due date. That’s why your provider will monitor you closely, and your baby will probably be delivered before you reach term.

• #2 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. […] Because high blood bile acid levels can be dangerous for the baby, 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.

• #2

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

  Ursodeoxycholic acid is the recommended first-choice drug for treating ICP. S-adenosyl-methionine may be used as a second-line drug or combination therapy for ICP treatment (weak recommendation, low evidence level). […] The timing of pregnancy termination in ICP should consider various factors such as maternal TBA levels, gestational age, obstetric history, previous ICP and stillbirth history, prenatal tests, and gestational age at onset of symptoms (strong recommendation, low level of evidence). […] 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. If not, the patient should be referred to a hepatologist for evaluation of potential co-existing hepatobiliary disease (strong recommendation, moderate level of evidence).

• #2 Cholestasis of Pregnancy: Causes, Symptoms, Treatment & More

  https://www.prepladder.com/neet-pg-study-material/obstetrics-and-gynaecology/cholestasis-of-pregnancy-causes-symptoms-risk-factors-diagnosis-treatment-prevention-and-complications

  There’s no known treatment for pregnancy-related cholestasis. […] Your prenatal care provider may recommend the following to alleviate intense itching: […] Since a history of pregnancy-related cholestasis may increase the probability of symptoms recurring while using estrogen-containing contraceptives, other birth control methods are generally indicated.

• #2 Itching and intrahepatic cholestasis of pregnancy – NHS

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

  Wearing loose clothes may help prevent itching, as your clothes are less likely to rub against your skin and cause irritation. […] You may also want to avoid synthetic materials and opt for natural ones, such as cotton, instead. These are „breathable” and allow the air to circulate close to your skin. […] Let your midwife or doctor know if you are experiencing itching so they can decide whether you need to have any further investigations. […] If you have ICP, you will probably be advised to give birth in hospital under a consultant-led maternity team. […] 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. […] You may also be offered a vitamin K supplement. This is because ICP can affect your absorption of vitamin K, which is important for healthy blood clotting. […] If you are diagnosed with ICP, your midwife and doctor will discuss your health and your options with you.

• #2 Intrahepatic Cholestasis in Pregnancy: Review of the Literature

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7290322/

  The guidelines of the Royal College of Obstetricians and Gynaecologists include a recommendation to induce premature delivery in ICP-complicated pregnancies in patients with severe biochemical disorders at 37+0 weeks. […] Due to the lack of recommendations based on randomized studies, the optimum management consists of inducing the delivery at gestation week 3637, particularly in cases of total bile acid levels exceeding 40 mmol/L. […] The likelihood of intrahepatic cholestasis of pregnancy recurring during a subsequent pregnancy is about 60%.

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

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

  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. These delivery decisions can be complex. You and your healthcare professional will discuss the risks and benefits of all your options before deciding what’s best for you and your baby. […] Management includes medication, antenatal testing, and early delivery.

• #2 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. […] 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.

• #2 What precautions to take for obstetric cholestasis?

  https://www.icliniq.com/qa/obstetric-cholestasis/what-precautions-to-take-for-obstetric-cholestasis

  For cholestasis of pregnancy, the serum bile acid test and LFT (liver function test) are to be done once weekly or fortnightly depending on the severity. […] You should consult a liver specialist or gastroenterologist. […] This condition might affect the growth and liquor (water level) around the baby. […] So, ultrasound to monitor the growth and water level around the baby every three to four weeks or early if clinical exam shows decreased growth or less amount of liquor. […] Sometimes, these patients require delivery before term as the severity or doppler changes warrants. […] Do not worry, but be in touch with your doctor regularly.

• #2 Intrahepatic Cholestasis of Pregnancy (On-demand CE)

  https://www.hivece.com/courses/icp

  Intrahepatic Cholestasis of Pregnancy (ICP) is a complex liver disease which typically presents in the third trimester of pregnancy. […] This course reviews the evidence for the best approach to risk-based management, and provides a plan for holistic preventative support of at-risk clients as well as the holistic treatment of clients with mild ICP in an out-of-hospital setting. […] 2.3 A New Protocol: Holistic Prevention for ICP Recurrence […] I love having this holistic protocol in my arsenal! We have managed a few ICP cases over the years and they seem always to end up in the hospital. Love these lab value cutoffs for safety and an approach that focuses on prevention! […] Excellent. I used the protocol that was suggested for a client that had cholestasis in her prior pregnancy. And it worked! I felt so confident and informed after this class. […] This course opened a whole new set of possibilities! […] This was a fantastic training! I have used the information with a current client who had ICP with her first pregnancy and this pregnancy has been complication free and my client feels amazing!

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

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

  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. […] 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: […] 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. […] 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.

• #2 Intrahepatic cholestasis of pregnancy: observational study of the treatment with low-dose ursodeoxycholic acid | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-015-0324-0

  UDCA was well tolerated. […] With low-dose UDCA treatment the obstetric outcome was good. We still recommend careful obstetrical follow-up. […] The treatment of ICP has mainly been symptomatic because the pathophysiology is still unresolved. […] It has been shown that UDCA causes a significant reduction in liver function tests in ICP. […] According to that study UDCA treatment should be recommended for women with ICP and it reduces adverse maternal and fetal outcome. […] In our study low dose UDCA treatment and induced delivery are safe and recommended as a treatment with ICP.

• #3

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

  We recommend that clinicians screen for high-risk factors of ICP, especially in high-prevalence areas; provide adequate prenatal education, prenatal care and assessment, monitor for abnormal blood pressure, blood glucose, and weight gain during pregnancy; and promptly identify and control high-risk factors (strong recommendation, moderate-level evidence). […] If pregnant women in mid-to-late pregnancy present with pruritus, associated scratch marks, jaundice, or gastrointestinal symptoms, we recommend that clinicians pay attention to these symptoms and screen for ICP in these women (strong recommendation, high level of evidence). […] The risk of stillbirth and preterm birth is related to the level of TBA. When maternal TBA level is 100 mol//L, the risk of stillbirth and preterm birth is significantly increased (strong recommendation, moderate level of evidence).

• #3 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. […] 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.

• #3 Intrahepatic Cholestasis of Pregnancy

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

  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. […] Delivery recommendations are based on bile acid levels as risks increase as bile acids become more elevated.

• #3

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

  Ursodeoxycholic acid is the recommended first-choice drug for treating ICP. S-adenosyl-methionine may be used as a second-line drug or combination therapy for ICP treatment (weak recommendation, low evidence level). […] The timing of pregnancy termination in ICP should consider various factors such as maternal TBA levels, gestational age, obstetric history, previous ICP and stillbirth history, prenatal tests, and gestational age at onset of symptoms (strong recommendation, low level of evidence). […] 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. If not, the patient should be referred to a hepatologist for evaluation of potential co-existing hepatobiliary disease (strong recommendation, moderate level of evidence).

• #3 Intrahepatic cholestasis of pregnancy: observational study of the treatment with low-dose ursodeoxycholic acid | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-015-0324-0

  UDCA was well tolerated. […] With low-dose UDCA treatment the obstetric outcome was good. We still recommend careful obstetrical follow-up. […] The treatment of ICP has mainly been symptomatic because the pathophysiology is still unresolved. […] It has been shown that UDCA causes a significant reduction in liver function tests in ICP. […] According to that study UDCA treatment should be recommended for women with ICP and it reduces adverse maternal and fetal outcome. […] In our study low dose UDCA treatment and induced delivery are safe and recommended as a treatment with ICP.

• #3 Intrahepatic Cholestasis in Pregnancy: Review of the Literature

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7290322/

  The guidelines of the Royal College of Obstetricians and Gynaecologists include a recommendation to induce premature delivery in ICP-complicated pregnancies in patients with severe biochemical disorders at 37+0 weeks. […] Due to the lack of recommendations based on randomized studies, the optimum management consists of inducing the delivery at gestation week 3637, particularly in cases of total bile acid levels exceeding 40 mmol/L. […] The likelihood of intrahepatic cholestasis of pregnancy recurring during a subsequent pregnancy is about 60%.

• #3 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 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). […] Timing of delivery is based on risk stratification guided by serum bile acid concentration and patient presentation. […] 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%.

• #3 ICP (Intrahepatic Cholestasis of Pregnancy) | PUSH Pregnancy | Stillbirth Prevention

  https://www.pushpregnancy.org/post/icp-intrahepatic-cholestasis-of-pregnancy

  The treatment of 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. […] The most important thing to know: DON’T IGNORE THE ITCH AND ALWAYS ASK YOUR PROVIDER IF YOU HAVE ANY CONCERNS!

• #4 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 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). […] Timing of delivery is based on risk stratification guided by serum bile acid concentration and patient presentation. […] 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%.

• #4 EBB 120 – Cholestasis in Pregnancy with Nicole Phelps – Evidence Based Birth®

  https://evidencebasedbirth.com/ebb-120-cholestasis-in-pregnancy-with-nicole-phelps/

  A systematic review published on February 14, 2019, in the journal Lancet (Ovadia et al), reviewed 109 studies of cholestasis of pregnancy and determined that the risk of stillbirth is higher when bile acid concentrations are 100 micromoles per liter or higher. […] Prescription treatment for cholestasis can reduce or stop the itching but has not been shown to improve fetal outcomes. […] However, high levels (especially above 100 mmol/L) are linked to increased risk of fetal death.

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