My bile acid blood tests are normal and I am still itchy– Should I have another blood test?

Yes, you should be retested as bile acid may take several weeks to show in your blood work.

 

My bile acid blood tests are normal - Should I still be delivered early?

This is a difficult question to answer. If you continue to itch and blood work is normal, since the bile acid test results take several days to receive from most labs both patients and doctors need to make a decision based on the risk to the baby. Also, it may be that you have been given medication that has brought your bile acids back down to normal or at least to under 40 micromol/L. and since the link to bile acids being the cause of stillbirth is strong, doctors take the side of caution and, even when the bloods levels are normal, deliver the baby by 37. Please refer to the links page of the website for medical reports with information on ICP/OC.

 

Why does my baby have to be delivered early?

Over the years researchers believe they have shown that delivering the baby early (around 37-38 weeks) reduces the risk of stillbirth. This is because it is known that stillbirth in ICP/OC tends to occur in the last few weeks of pregnancy. The reason for this is not completelty understood, although it may be linked to all the changes that take place in the woman as her body prepares for labor. Many doctors believe the benefits of delivery at 37-38 weeks may outweigh the risks associated with early delivery.

 

 

Will OC harm my baby?

ICP poses several risks that are of great concern. ICP is associated with an increased risk of stillbirth (intrauterine death of baby), premature labor, fetal distress, maternal hemorrhaging and meconium passage in utero. The risk of stillbirth in an ICP/OC pregnancy is believed to be the same as that for a normal pregnancy (1%) with active management (which usually means treatment-Urso and choosing to deliver early). Most doctors chose to monitor women with ICP/OC closely and deliver the babies early (no later than 37) in order to minimize the risk to your baby. 

 

My doctor said that if I had ICP I would be jaundiced. Is this true?

There are many symptoms associated with ICP mainly itching, however not every ICP patient has all. You do not have to be jaundice to have ICP. There seems to be a misconception that if a patient has ICP she will always present with jaundice (yellow appearance to the skin). Only a very small percentage of women get jaundiced during ICP.

 

Why doesn't Aveeno baths and Benadryl work for the itching?

ICP itching is different than normal itching because the cause of the itching is internal, and more specifically, it is either directly or indirectly caused by bile salts in the bloodstream. "Normal" itching is caused by histamines and it can often be treated by topical lotions or anti-histamines. Pruritus caused by ICP does not respond to either because of it's internal nature.

 

I have a rash all over and am itching everywhere! Is this ICP?

The question to ask here is - Is the rash what is causing you to itch, or did scratching cause the rash? There is a complication during pregnancy called PUPPP that presents with a rash and is accompanied by severe itching. In this case the rash is the cause of the itching. Often, a woman with ICP will scratch herself and cause a rash-like appearance to her skin. When in doubt as to which came first, the rash or the itch, a doctor can order a serum bile acid test to be sure. In a handful of cases, ICP has indeed caused a rash, but this is not typically how it presents.

 

I am expecting triplets, is this more dangerous?

There is no evidence as yet to show that expecting more than one baby increases the risk of ICP/OC-related fetal distress or stillbirth. Women carrying multiples appear to have a higher risk of developing ICP/OC. Also, women with multiple pregnancies may have a higher risk of going into early spontaneous labor.

 

Should I have my gall bladder removed to cure ICP?

There is no cure for ICP. Unfortunately for woman who experience ICP, a cholecystectomy will not cure cholestasis of pregnancy. For most women, there are no changes in the intensity of itching after a removal. Those that experience ICP have a greater incidence of gall stones, often creating the need for gall bladder removal, but the process itself is not a cure. Also, generally this does not have an effect on the severity of disease. Many women have had their gall bladders removed in between pregnancies and have seen no direct correlation between the gall bladder and the symptoms of ICP.

 

Is there anything else I can do?

Please note that these are tips that woman who have experienced ICP have found useful, however the medicine Urso helps to improve ICP, meanwhile the below are complimentary self-helps that may relieve your discomforts from the itching. Eat healthy, drink plenty of water, wear cool & loose cotton clothing, keep temperatures low and maintain a low stress level. Some women have tried complementary medicines such as milk thistle and dandelion. However, it is important, as with all complementary medicines, that you discuss this with your doctor.

 

Will I get OC again?

Reported recurrence rates vary with some researchers stating 60% and others up to 90%. What is known is that women who have OC in one pregnancy are very likely to develop it again in a subsequent one.

 

Will it be worse next time?

There has been no research that has shown ICP will be worse in subsequent pregnancies. In your next pregnancy you may be more in tune if you have ICP symptoms such as the itch. Every ICP case and pregnancy is quite different and your symptoms may vary. In my personal experience I had milder symptoms that started later in my pregnancy during my third pregnancy compared to my first two. Please also keep in mind that there is a chance that you may not develop ICP at all in a subsequent pregnancy! 

 

Can I breast feed my baby after ICP?

Absolutely! Breastfeeding is completely safe and normal after ICP. Some doctors may suggest for their patients to continue their prescription of Actigall/Urso to help rid the body of "leftover" bile acids. The medication may pass into the breast milk, but may help the baby's immature liver to rid their own body of residual bile acids as well as help with jaundice.

 

Will the itching go away after delivery?

There is still much to be learned about the exact causes of ICP and its manifestation, but researchers are currently investigating genetic, hormonal and environmental factors. However, ICP is sometimes a result of an underlying liver disorder. 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, however special attention should be given to patients whose itching intensifies after delivery or does not go away at all. Postpartum Serum Bile Acid testing and Liver Function testing are suggested for ICP patients to ensure overall health. A differential diagnosis may include Hepatitis C, AIDS, anemia, Benign Recurrent Intra-hepatic Cholestasis, and bile duct obstruction. Other conditions that should be ruled out in OC are infections with hepatitis A and B, cytomegalovirus, and Epstein-Barr virus, and autoimmune hepatitis. With regard to the latter, antimitochondrial antibodies can be obtained to rule out primary biliary cirrhosis and anti-smooth muscle antibodies to exclude autoimmune chronic active hepatitis. Appropriate imaging studies should also be done to rule out obstructive cholelithiasis.

Do I need to have my liver checked by a specialist after my baby is born?

Postpartum Serum Bile Acid testing and Liver Function testing are suggested for ICP patients to ensure overall health. This is because sometimes there may be an underlying liver condition which is not ICP/OC that has caused the itching and abnormal liver readings during your pregnancy. If the results still show elevated ALT/AST or bile acid levels you will need to have the tests repeated. If, after six months your levels are still not improving it may be advisable to be referred to a specialist called Hepatologist or Gastroenterologist. You may have another liver condition or your liver is just taking a little while to settle back to normal. This has occurred with women who have had ICP/OC.

 

What contraception can I use after my OC pregnancy?

 

The only methods of contraception that are likely to cause problems for women who have had ICP/OC are those containing hormones. However, there have been no large studies regarding the use of contraception following an ICP/ OC pregnancy so you may be given conflicting advice about what you can or can't use. Given that it has yet to be established whether it is progesterone or estrogen that 'triggers' the condition it may be prudent to use only those hormonal forms of contraception that bypass the liver, such as the Mirena intra-uterine device. However, anecdotal evidence is showing that many women can tolerate the mini pill and some women are also able to use a low dose combined oral contraceptive pill. If you do decide to take the pill after consulting with your doctor, it is important to make sure that your liver function is normal before you begin. It should also be checked again about six weeks later. This is easily checked by requesting a liver function test (blood test). If you start to itch after you begin to take the pill you should stop. However, this itching shouldn't be confused with cyclical.