Intrahepatic cholestasis (ICP, also known as obstetric cholestasis) is a condition of pregnancy that commonly manifests as itching and in rare cases jaundice.

It is important to evaluate the cases with symptoms of itching especially at later stages of pregnancy for ICP since this condition may be harmful for the unborn baby.

The symptoms of the condition intrahepatic cholestasis of pregnancy include itching, jaundice and so forth. 1-7

Itching in pregnancy and Intrahepatic cholestasis of pregnancy (ICP)

Some amount of itching is common during pregnancy. This is due to the increased blood supply to the skin layers in normal pregnancies.

In addition, the stretching of the skin over the abdomen as the baby grows also leads to itching of the skin. This is usually mild and can be treated using soothing lotions like Calamine lotion etc. Itching is seen in 1 in 5 pregnancies normally.

Itching seen in obstetric cholestasis is more intense. It usually begins after 25 to 28 weeks of pregnancy. There may be severe itching which is especially worse at nights and affects the arms, legs, soles and palms. It may also affect face, back, chest and breasts.

The patient may present with damage and scratch marks over the skin. These are called excoriations and may be complicated with bacterial infections as well.

The itching sites may sometimes bleed due to excessive scratching. Due to chronic itching the nails of the patient may also appear shiny and smooth.

The itching is generally worse at night and interferes with sleep.

The itching is present for days or weeks before the blood tests reveal abnormalities in the liver function tests.

The itching often resolves after giving birth and there are no long term health problems.

Jaundice and Intrahepatic cholestasis of pregnancy (ICP)

The increased build-up of bilirubin leads to jaundice, dark colored urine and pale white clay colored stool. This may be seen in very few severe cases of ICP.

At least 1 in five women with ICP may go on to develop mild jaundice. This is manifested as yellowish discoloration of skin, nail beds and whites of the eyes.

Other symptoms of Intrahepatic cholestasis of pregnancy (ICP)

In addition to itching and jaundice, other symptoms include:

• general weakness, feeling of unwell and tiredness and easy fatigability
• there may be loss of appetite - some women complain of nausea and vomiting as well

Risks to the baby

The risks to the baby include birth before due dates (premature birth), risk of derangement of vital signs (fetal distress) during labor and a small risk of still birth.

Long-term risks of Intrahepatic cholestasis of pregnancy (ICP)

Risks of long term liver problems after birth of the baby is low.