Itching all over is quite often the only symptom a woman notices when she develops ICP. Due to the fact that itching is considered a normal part of pregnancy, testing for ICP is often overlooked. This can be a dangerous mistake. Any complaint of itching during pregnancy should be taken seriously and be evaluated.
Two tests should be administered to women who are experiencing pruritus which include the following:
The serum bile acid test is the most sensitive indicator of ICP. A diagnosos of ICP is often established when bile acid levels rise above 14, however labs have differing standards of measurement. The SBA test is a specialized test should should be administered after a period of fasting, as eating certain foods may increase bile production.
IMPORTANT NOTE REGARDING BILE ACIDS TESTINGS: Currently, there are only a handful of labs in the U.S. and abroad who have the equipment necessary to perform this test which can result in a delay. This delay should be taken into consideration when planning treatment, especially if the patient is 36 weeks pregnant or more. Bile acids have been known to triple in value in less than a weeks time period. If ICP is suspected based on symptoms alone and a patient is 34 weeks pregnant or more, doctors may wish to prescribe medication or induce labor before receiving test results. This is especially important to consider if a patient in her third term has a history of itching in previous pregnancies, has a family history of ICP, has been itching for a prolonged period of time (2 weeks or more) or has experienced stillbirth.
A liver function test that measures the liver enzymes in the blood should also be administered when determining ICP, but should not be the sole criteria for a diagnosis! This is due to the fact that it is possible for a patient to have normalized liver enzymes and elevated bile serum results. In ICP, bile serum levels typically rise before liver enzymes increase. Receiving results of elevated LFTs before receiving the results of a SBA test should be considered protocol to administer UDCA as a precautionary measure to ensure the safety of the unborh baby. If bile serum results return normal and LFTs are found to be elevated for underlying causes, the medication should still be of no harm to the patient or baby.
Standard liver enzymes include Alanine Transaminase (ALT), Aspartate Trasaminase (AST), and Alkaline Phosphotase (ALK) and are often referred to as the transaminases.
ALT is the enzyme produced within the cells of the liver. The level of ALT abnormality is increased in conditions where cells of the liver have been inflamed or undergone cell death. As the cells are damaged, the ALT leaks into the bloodstream leading to a rise in the serum levels. Any form of hepatic cell damage can result in an elevation in the ALT. The ALT level may or may not correlate with the degree of cell death or inflammation. ALT is the most sensitive marker for liver cell damage.
AST also reflects damage to the hepatic cell. It is less specific for liver disease. It may be elevated and other conditions such as a heart attack. Although AST is not a specific for liver as the ALT, ratios between ALT and AST are useful to physicians in assessing the etiology of liver enzyme abnormalities.
Alkaline Phosphatase (ALK), is another liver enzyme that is evaluated during a routine LFT, but because this value is normally elevated in pregnancy, it's contribution to the diagnosis of ICP is typically disregarded by specialists.
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