Obstetric cholestasis is also known as intrahepatic cholestasis of pregnancy. Until most recently, doctors didnít know much about the disease. It was often misdiagnosed and mismanaged. In reality, the condition can be very dangerous to the foetus and the mother. It is estimated that seven out of every 1,000 pregnant women in the US have this disorder and most doctors believe the condition is often undiagnosed. This condition often gives rise to a solicitors medical negligence compensation claim due to mismanagement by healthcare professionals.
If your obstetric cholestasis (ICP) was worsened or was not diagnosed due to mistakes by a doctor or hospital, it is important that you protect your legal interests and make certain that you are compensated for injury to yourself or your child. Our obstetric cholestasis medical negligence solicitors normally deal with personal injury claims using a no win no fee arrangement which means that if you don't win then you don't pay them their professional costs. If you would like legal advice at no cost then just complete the contact form or email our lawyers offices or call the solicitors helpline and an obstetric cholestasis medical negligence solicitor will telephone to discuss your potential claim.
Obstetric cholestasis which is also called intrahepatic cholestasis of pregnancy (ICP) affects about 1% of women during pregnancy and is a liver disorder caused by a reduced production of bile fluids which causes temporary itching, particularly on the hands and feet, that disappears within a few weeks after delivery. The condition poses a serious risk of harm to the unborn child and unless it is recognised promptly and treated properly can be fatal to the unborn child. Mothers who suffer from this condition will need to have their baby delivered early to help prevent the possibility of stillbirth and there are usually increases in intensity in subsequent pregnancies. If you think that your condition was worsened or not treated as a result of medical negligence, contact our obstetric cholestasis solicitors for advice at no cost.
High Levels of Oestrogen
The condition is due to high levels of oestrogen produced during pregnancy inhibiting bile flow and concentrating bile salts in the blood, resulting in itching and occasionally jaundice, which can result in stillbirth. It is often a hereditary condition and can skip several generations. Any pregnant woman who is itching more than normal should have blood tests for evaluation of liver function. Whilst the condition is relatively rare and healthcare professionals are often not knowledgeable about the proper remedial procedures, obstetric cholestasis claims are not uncommon.
The itching usually starts on the soles of the feet and the palms, extending to the rest of the body and is usually worst during the night. Mild jaundice affects about 20% of patients and some babies are born jaundiced. Mothers may suffer from malabsorption of vitamins, worsening maternal nutrition and there is about a 20% risk of postpartum haemorrhage which may be caused by inadequate absorption of vitamin K, which is needed for the blood to clot.
Intrahepatic cholestasis of pregnancy or ICP is a condition of the liver that affects the flow of bile through the biliary ducts. Bile doesnít pass through the hepatic duct so that digestion and absorption of fats is interfered with. It can cause severe itching of pregnancy and, if it becomes severe, it can cause actual jaundice. It is a phenomenon of the third trimester of pregnancy when the pregnancy hormones are at their peak. In rare cases, it can start in the first trimester and last throughout the pregnancy. The condition appears to have some genetic component because women who get it have a family history of liver disease or similar problems of pregnancy. The exact cause of the disease, however, is not really known.
The most common symptom of intrahepatic cholestasis of pregnancy is severe itching. It can be so bad that it interferes with sleep and activities of daily living. The most common locations of the itching are the palms of the hands and the soles of the feet. Jaundice is a less common symptom but indicates that the disease is more severe. Jaundice is manifest in 20 percent of women who have ICP. Other symptoms include pale stools and dark urine, tiredness, mild depression and loss of appetite. Severe depression is rare but possible, as is pain in the upper right quadrant and nausea or vomiting.
Consequences of ICP are not much of a problem for the woman but there can be significant risks to the foetus, including haemorrhage, fetal distress, stillbirth and premature birth. In fact, 44 percent of women who have ICP will have their baby before 37 weeks gestation.
The best treatment for intrahepatic cholestasis of pregnancy involves diagnosing the disease early. There are medical tests that can be done when ICP is suspected. This includes the serum bile acid testóthe most accurate test for the disease. It is a fasting test that measures the bile acid content in the blood. If it is elevated, the condition is almost always due to ICP. The biggest problem is that not very many laboratories do this test so if the disease is suspected, it should be treated without the results of the test.
Historically speaking, ICP was treated with cholestyramine, a cholesterol-lowering medication. Recently, however, it has been found to be relatively ineffective in dropping the level of bile acids in the blood. Treatments that have been found to be more effective include Actigall, which replaces bile acids in the blood. It has been shown to reduce the incidence of stillbirth. Vitamin K helps increase the absorption of fat-soluble vitamins and prevents bleeding complications. Steroids can be given before 32 weeks gestation in order to reduce the risk of breathing problems in the preterm infant. Steroids also control itching.
Monitoring during pregnancy is vital to make sure the baby is developing properly. If the baby quits growing or shows signs of distress, an early delivery is proposed. If the baby reaches thirty-six weeks gestation and has mature lungs, an early delivery can be planned to get rid of the itching and to deliver a healthy baby. A caesarean section is not necessary after 36 weeks.
Fortunately, delivery of the infant cures the problem of cholestasis. Even so, the liver enzymes should be evaluated after the delivery until they return to normal. Those women who have had ICP before have a 60-70 percent chance of getting it again.
Obstetric cholestasis is also known as intrahepatic cholestasis of pregnancy and is a relatively new diagnosis in the world of obstetrics. Women who had this disorder in the past were written off as having something else or were ignored altogether. It is now known that this is a potentially dangerous condition of pregnancy that affects 0.7 percent of all pregnancies or around 7 out of a thousand pregnancies. There are likely many more women undiagnosed with the disease, raising the incidence rate.
ICP occurs only in pregnancy. It is a condition that affects the flow of bile through the liver. Bile controls the digestion of foods, particularly fats. Bile acids build up within the bloodstream so that severe itching occurs. Some women actually develop jaundice if the disease is severe. ICP is a condition of the third trimester primarily. This is when the hormones of pregnancy are the highest and this affects the flow of bile acids. Rarely, a woman can develop the condition in the first trimester, yielding severe itching throughout pregnancy.
No one knows the exact cause of obstetric cholestasis or ICP. It does believe to be related to heredity as about half of all women with the disease have a history of liver problems within their family.
The symptoms of obstetric cholestasis or ICP include severe itching. The itching can be severe and can occur during the woman's sleep. It can occur on any body area but is most common in the palms of the hands and the soles of the feet. The whites of the eyes can turn yellow and the skin can turn yellow in a condition known as jaundice. Jaundice occurs in about twenty percent of women with ICP or obstetric cholestasis. Other symptoms include dark, cola-colored urine, pale stools, loss of appetite, fatigue and depression, made worse by the chronic, debilitating itching. In some cases, the depression can be severe and require treatment. Nausea and vomiting are possible as is right upper quadrant abdominal pain from liver inflammation.
It is fortunate that obstetric cholestasis or ICP doesn't harm the fetus in most cases. It can cause some pregnancy-related risks including haemorrhaging within the pregnancy, preterm birth in about 44 percent of cases, still birth and foetal distress.
So how is ICP diagnosed? The itching is a good sign that a woman has ICP or obstetric cholestasis. There are tests that can be done if the disease is expected on the basis of severe itching. This can include a serum bile acid test. This is a fasting test in which bile acids are measured in the blood. It is a difficult test to come by as most labs do not do this test. This can delay the diagnosis. Most women choose to be treated before the test comes back as it often has to be sent off and takes a while to come back. Liver function tests may show abnormalities in liver enzymes. It is a test that may or may not be abnormal in cases of ICP. Abnormalities of liver function tests often show up much later after the itching starts so they aren't very sensitive tests and the diagnosis is clear long before the liver function tests become abnormal.
The treatment of obstetric cholestasis or intrahepatic cholestasis of pregnancy involves several choices. Actigall or ursodeoxycholic acid is a medication that replaces toxic bile acids within the bloodstream, reducing the itching and the risk of stillbirth. Vitamin K therapy replaces the lost vitamin K that happens because bile salts aren't allowing for vitamin K uptake into the body. Steroids may be used to mature the foetal lungs so that, in the event of a preterm birth, the foetal lungs are more mature. The itching is also reduced with the use of steroid medication.
There is careful monitoring of a woman with obstetric cholestasis so that the infant is found to mature normally and without foetal distress. Caesarean section may be done prior to term at around 36 weeks gestation to prevent stillbirth and fetal distress in the latter part of the pregnancy.
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The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here