Scientific definition: Intrahepatic cholestasis of pregnancy (ICP) or obstetric cholestasis is characterized by pruritus and an elevation in serum bile acid concentrations. It is the most common liver disease unique to pregnancy!

In simple words, it is a potentially serious liver disorder that can develop late in pregnancy; typically, in the 3^rd trimester and shall rapidly resolve after delivery. Normally, bile acids flow from your liver to your gut to help you digest food. In ICP, the bile acids do not flow properly and build up in your body instead, that causes severe itching. 

Implications for pregnancy

Having obstetric cholestasis is unlikely to harm you, but it causes itching of the skin that can be very uncomfortable; it is often worse at night, which can keep you awake and leave you feeling exhausted. However, symptoms get better post birth!

Although unusual, it's possible for OC to affect the ability of your blood to clot. If you have a pre-existing clotting disorder, pale stools or severe OC starting in early pregnancy, your care provider may offer you a vitamin K supplement to help your blood to clot. Unfortunately, if medication / supplementation doesn’t lower bile levels, your care provider may recommend delivering your baby early. 

Implications for birth

·       One of the main concerns with OC is that your baby may be born early.

·       Also, your baby is more likely to pass his/her first poop (meconium) before birth. This can sometimes cause breathing problems for your baby, if the meconium gets into his/her airways (meconium aspiration syndrome). 

·       Furtherance, bile acids upon entering your baby’s lungs while he/she was in your womb may also cause breathing problems even after birth.

·       Many studies have concluded that OC also causes fetal distress.

·       Lastly, high levels of bile acid are also known to increase the risk of stillbirth.

Statistics

Clinical studies clearly show that when obstetric cholestasis complicates pregnancies it may lead to premature births in up to 60%, fetal distress in up to 33%, and intrauterine death in up to 2% of patients. 

Active management

There is no cure for obstetric cholestasis except the birth of your baby. However, some treatments may ease symptoms for most women. Such treatments might include:

1.      Cool baths

2.     Loose cotton clothing

3.     Skin creams and ointments

4.    Rest

Takeaway

There is a significant risk for fetal morbidity and mortality in OC with evident implications for future health of the offspring. Hence, early diagnosis and active maternal and fetal surveillance are of utmost importance to avoid adverse outcomes of obstetric cholestasis.