In short, intrahepatic cholestasis of pregnancy is a potentially-serious liver condition that occurs during pregnancy. Intrahepatic cholestasis of pregnancy (ICP) is a potentially serious liver disorder that can develop in pregnancy. While most pregnant women experience some itch from time to time, itching without a visible rash, or persistent or extensive itch symptoms should be reported to the midwife or obstetrician. [8] Geenes V, Chappell LC, Seed PT, Steer PJ, Knight M, Williamson C. Association of severe intrahepatic cholestasis of pregnancy with adverse pregnancy outcomes: a prospective population-based case-control study. Although intrahepatic cholestasis of pregnancy poses little risk for women, this condition carries a significant risk for the fetus, including complications such as preterm delivery, meconium-stained amniotic fluid, and stillbirth. Intrahepatic cholestasis of pregnancy and associated adverse pregnancy and fetal outcomes: a 12-year population-based cohort study. Diagnosis/definition: Intrahepatic cholestasis should be suspected when pruritis develops in the absence of a rash. Most women with this condition present in the third trimester (although it can present as early as seven weeks) with itching without a rash. Furthermore, other causes of hepatitis, like hepatitis viruses, cancer and certain medications, should also be considered. Use of this Web site constitutes acceptance of Terms of Use, Coalition to Advance Maternal Therapeutics, Contemporary Guide to Practice Management, OB-GYN, Sub-specialist, Certified Nurse Midwife and Laborist, American Journal of Obstetrics & Gynecology. Epidemiology/Incidence: 0.3-0.5% among the general population with up to 15% incidence in Latin American countries. Clin Liver Dis. However, there are instances when itching may be a symptom of ICP. Rash During Pregnancy ... Intrahepatic cholestasis of pregnancy is a condition characterized by generalized pruritus caused by deposition of bile acids in the skin. Pruritus (itching) is a common symptom of pregnancy, affecting around 23% of women. The condition triggers intense itching, but without a rash. Intrahepatic cholestasi 1. OB-GYN, Sub-specialist, Certified Nurse Midwife and Laborist Introduction: Previous studies of fetal effects have suggested that intrahepatic cholestasis of pregnancy is associated with a higher rate of adverse neonatal outcomes including preterm birth, neonatal respiratory distress syndrome, meconium-stained amniotic fluid, neonatal intensive care unit admission, and stillbirth. Lab evidence of cholestasis includes elevated bile acids (> 10 umol/L). Prevalence is influenced by genetic and environmental factors and varies between populations worldwide. 1999 Aug;3(3):603-32. [7] Genetic mutations in the hepatocellular transport protein ABCB4 (MDR3), which controls secretion of phosphatidylcholine into bile, have been found in cases of ICP. Pruritic urticarial papules and plaques of pregnancy (PUPPP) is a rash that typically develops in the third trimester. Most cases of itching are due to the usual annoying but not life-threatening culprits like dry skin, allergies, or eczema. Prenatal care:  Upon diagnosis of intrahepatic cholestasis, prenatal intervention for treatment of symptoms of cholestasis is indicated. The incidence of ICP in Chile has dropped from 14% of pregnancies before 1975 to 4% in 2016. Cholestasis of pregnancy. However, they can return during later pregnancies. Itch occurs in about one in five pregnant women. In cases of family history for intrahepatic cholestasis, there may be up to a 92% rate of incidence in planned pregnancy. Testing has not been demonstrated to improve fetal outcomes that happens during pregnancy ( )... 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