Patient's question:
Description: I was diagnosed with intrahepatic cholestasis of pregnancy on February 6, 2008. At that time, I was 225 days pregnant, had jaundice, poor appetite, and a preference for very cold water, which made me vomit. I went to the hospital for a check-up. Due to the backward medical level of the hospital, the condition was not diagnosed. I stayed in the hospital for 2 days, and suddenly the fetus died in the womb. Later, through tests, it was found to be intrahepatic cholestasis of pregnancy. I have now recovered. A year later, we are preparing to get pregnant. Dear medical angels, what routine tests should be done before pregnancy for this condition, and what should be paid attention to after pregnancy? Thank you!Doctor's answer:
1. Intrahepatic Cholestasis of Pregnancy (ICP) mostly occurs in the second and third trimesters of pregnancy, with a few cases occurring in the second trimester. It is characterized by skin itching and high levels of bile acids.2. It primarily threatens the fetus. The incidence rate ranges from 0.8% to 12%.
3. The exact cause is unclear, but it may be related to factors such as estrogen, genetics, and the environment. Clinical research suggests that ICP may be caused by abnormal estrogen metabolism and high sensitivity of the liver to estrogen.
4. It is characterized by skin itching and jaundice. The presence or absence of jaundice in ICP patients is closely related to fetal prognosis.
5. Bile acids in bile are mainly composed of cholic acid (CG) and taurine, with a ratio of 3:1. Clinically, the level of bile acids is assessed by measuring CG levels in the serum.
6. Elevated serum bile acid levels are the most specific evidence of ICP. Serum bile acid levels rise weeks before the onset of itching symptoms or before transaminase levels increase. The higher the value, the more severe the condition, and the earlier the onset of itching.
7. In addition to liver-protecting treatment, prednisone may be administered to patients with more severe conditions to reduce estrogen and bile acid levels in the blood, thereby alleviating itching symptoms and improving liver function more quickly.
8. Do not panic. With timely control, it can be improved. ICP often has a family history or occurs after taking oral contraceptives, leading to skin itching symptoms. ICP does not pose significant harm to the pregnant woman and does not leave behind chronic liver damage. Itching and jaundice usually subside on their own within 1–2 weeks postpartum. In some cases, reduced bile acids in the intestines may affect vitamin K absorption, leading to decreased synthesis of certain clotting factors and postpartum hemorrhage. The main harm of this condition lies in its adverse effects on the perinatal infant. Bile acids can stimulate the uterus and decidua to release prostaglandins, prematurely triggering uterine contractions and causing preterm labor. It is recommended that you go to the hospital for treatment and monitoring of the fetus under the guidance of a doctor.