Intrahepatic Cholestasis of Pregnancy refers to a liver condition in which the normal flow of bile is impaired resulting in severe itching in the mother and a risk for stillbirth and prematurity (delivery before term) in the baby.

1. Role of Serum Bile Acids
in Intrahepatic Cholestasi
of Pregnancy (ICP)
Dr. Sunita Kapoor
Director
City X-Ray & Scan Clinic

2. Intrahepatic Cholestasis of Pregnancy refers to
a liver condition in which the normal flow of bile
is impaired resulting in severe itching in the
mother and a risk for stillbirth and prematurity
(delivery before term) in the baby.
What is
Intrahepatic
Cholestasis of
Pregnancy?
ICP usually develops during the last third of
pregnancy, when hormone levels are highest.
ICP is also referred to as obstetric cholestasis,
cholestasis of pregnancy, and pruritus/prurigo
gravidarum.

3. There is a defect in the excretion of bile from
the liver resulting in rising of bile acids in the
blood.What causes
Intrahepatic
Cholestasis of
Pregnancy?
The exact mechanism is still not fully
understood, but current research suggests
genetic, hormonal and environmental factors.
Recently a particular gene mutation (change in
a specific gene) has been detected in some
ICP patients.
ICP typically develops when there are high
hormone levels in late pregnancy and in
women carrying twins or triplets. It may also
occur in women on the oral contraceptive pill

4. Yes – mothers and sisters of patients with ICP
are at higher risk of developing ICP, because
there seems to be a change in one of your
genes, which may be present in other family
members.
Does
Intrahepatic
Cholestasis of
Pregnancy
run in
families?
ICP also tends to recur in subsequent /
following pregnancies (60-90%).

5. The main feature is a sudden onset of severe itch that will
typically increase in severity until you are either treated for it
or delivery takes place. It often starts on the palms and
soles, but then quickly involves the whole body.
What are the
features of
Intrahepatic
Cholestasis of
Pregnancy
and what does
it look like?
The longer the itch persists, the more skin changes due to
scratching may be present.
These vary from fine scratch marks (excoriations) to 5-10mm
raised lumps (so-called prurigo nodules) typically involving
the shins, arms and buttocks. Apart from these changes,
there is usually no rash associated with ICP.
Loss of sleep, loss of appetite, and an inability to perform
normal daily tasks can be a result of the intense itching.
Less common symptoms (<10% of patients) include dark
urine and/or pale stools (greyish in colour), jaundice (the
white of your eyes and sometimes the skin becomes
yellowish), pain in your belly, and nausea.

6. The best available test for ICP is the “serum bile acid test”.
A diagnosis of ICP is certain when bile acid levels are
elevated above the normal range. As bile acids are not part
of a routine liver function test (LFT), this test must be
specifically requested by your doctor.
How will
Intrahepatic
Cholestasis of
Pregnancy be
diagnosed?
However, there are only few laboratories that have the
equipment necessary to perform this test, because of this
the diagnosis may be delayed.
A routine liver function test (LFT) that measures liver
enzymes in the blood should also be done when checking
for ICP. However, this test may be normal in ICP, meaning
you may still have ICP, because “serum bile acid levels”
typically rise before liver enzymes increase. If “serum bile
acid levels” are normal but LFTs are found to be increased,
your doctor will search for other liver diseases for example
hepatitis, other tests are required to diagnose this.

7. How can
Intrahepatic
Cholestasis of
Pregnancy be
treated?
Two important steps may be taken
Reducing the bile acids in your bloodstream:
Ursodeoxycholic acid (UDCA - a naturally occurring bile
acid) is currently the best treatment of ICP. UCDA
improves the liver function, helps to reduce the toxic (bad)
bile acid concentration in the bloodstream and improves
bile acid transport across the placenta (takes it away from
the baby). However, UDCA is not licensed for use in
pregnancy. It may be prescribed on an individual base,
with what is called ‘informed consent’.
Delivering the mother as early as possible.
However, the development of the baby’s lungs is
important, and usually delivery may be after they are
fully developed at weeks 36 or 37 of your pregnancy.
01
02

8. Is any special
monitoring
required?
Certain weekly check-ups
upon diagnosis are suggested;
they include a “biophysical
profile” (test that uses the non-
stress test and ultrasound to
examine foetal movements,
heart rate, and amniotic fluid
amounts), cardiotocography
(evaluates foetal heart rate),
Doppler flow study.

9. Yes.
Yes. Neither ICP nor treatment with UDCA
influences breastfeeding negatively.
Is normal
delivery
possible?
Can women
with ICP still
breastfeed?

10. REFERENCES
Black, Edwards, Lynch, Ambros-Rudolph. Obstetric and Gynecologic
Dermatology. 3rd edition, 2008 (UK)
Schaefer, Spielmann, Vetter. Arzneiverordnung in Schwangerschaft und
Stillzeit. 8th edition, 2012 (Germany)
Schaefer, Peters, Miller: Drugs during pregnancy and lactation. 2nd edition
2007 (English)
Briggs, Freeman, Yaffe. Drugs in pregnancy and lactation. 7th edition, 2005
(USA)
Leaflet of the EADV task force “skin disease in pregnancy”,Updated 15.06.2013

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