Treatment of ICP (Intrahepatic Cholestasis)

• Biophysical Profile - test that uses the nonstress test and ultrasound to examine fetal movements, heart rate, and amniotic fluid amounts.
• Cardiotocography - evaluates fetal heart rate.
• Doppler Flow Study - A type of ultrasound which use sound waves to measure blood flow.
• Ultrasound - diagnostic imaging technique which uses high-frequency sound waves to create an image of the baby's body and organs and the surrounding tissues.

Prothrombin Time (PT)
Due to the increased risk of Vitamin K malabsorption, clotting times (PT) should be checked at least weekly close to the date of delivery and at delivery to prevent the risk of maternal hemorrhage and intra-cranial hemorrhage in the infant. Intra-cranial hemorrhaging is a risk to the infant in utero as well as after delivery, so it is vital that the newborn infant receive a Vitamin K injection upon delivery.

After Delivery

ICP is believed to be a condition caused by a gene mutation resulting in the liver's inability to cope with high levels of estrogen present in the body. However, ICP is sometimes a result of an underlying liver disorder or other complication. It is normal for patients to continue itching for some time after delivery, particularly with cases that have been prolonged or in cases where a patient has had several pregnancies in a short time frame, but special attention should be given to patients whose itching intensifies after delivery or does not go away at all. Post-partum Serum Bile Acid testing and Liver Function testing are suggested for ICP patients to ensure overall health. A differential diagnosis may include Primary Bilary Cirrhosis, Hepatitis, AIDS, anemia, Benign Recurrent Intra-hepatic Cholestasis, and bile duct obstruction.

UNDERSTAND THE RISKS

Sudden Stillbirth
Elevated levels of serum bile acids have been proven to increase the incidence of meconium passage, therefore increasing the risk of sudden stillbirth. Meconium passage is also associated with umbilical vein constriction which can lead to a reduction in umbilical flow. Meconium staining is reported often among ICP patients and one of the most dangerous risks associated with ICP. Proper medication and early delivery can help to eliminate this possible risk.

Fetal & Maternal Hemmorhaging
Cholestasis patients have a reduced ability to absorb fat-soluble vitamins (A,D and K). This may lead to Vitamin K deficiency. Because of the risk of intra-cranial hemorrhage in the infant and post-partum maternal bleeding, water soluble Vitamin K should be administered to both mother and baby. There have been reports of maternal hemorrhage as well as stillbirth in utero and post-partum due to ICP induced Vitamin K Deficiency.

Premature Labor
ICP has been associated with a substantial rate of preterm birth. In a French study involving 40 ICP patients, 32.5% of the patients were reported to have preterm labor. Earlier presentations of ICP seem to carry an even greater risk of preterm labor, as well as twin or triplet pregnancies.

SELF-HELPS

Lower Fat Intake
Many women notice that eating a lower fat diet helps with the severity of the itching they experience. This may be due to the fact that eating fats prompts the body to secrete bile acids into the stomach to begin the digestion process, which may mean more bile acids eventually entering the blood stream.

Water, Water & More Water
It is important that cholestasis sufferers have a good intake of water. Water helps to flush toxins out of the body and helps the body systems work more efficiently.

Milk Thistle, Dandellion Root, and SAMe
Milk Thistle and Dandelion Root or Tea are safe herbs for pregnancy are have been proven to greatly strengthen and benefit the liver. SAMe is a manufactured susbstance produced that has shown to have some benefits to ICP sufferers. In a study comparing SAMEe with UDCA, SAMe was found effective, but not as effective as UDCA. Before taking any herb or drug, please consult with your doctor or midwife. Black Kohosh is an herb known for it's benefit to the liver, but it contribute to preterm labor and should therefore be avoided before 36 weeks.