Four days before my wedding day, I woke up franctically scratching my wrists and covered in a bumpy rash. I called my midwife right away who suggested that I go to the hospital as soon as possible. It was there that they did a serum bile acid test (a blood test to test the bile levels produced by your liver) along with an ultrasound and some additional blood work. The bile acid test took about one week to get the results which indicated I indeed had Cholestasis.
So, what is ICP? ICP is a disorder specific to pregnancy that affects the liver's ability to transport the bile out of the cells normally. This causes elevated bile levels which can pose serious risks to the unborn baby. According to my midwife, most women (80%) notice the signs and symptoms of ICP in the third trimester, however I was diagnosed early at 18 weeks.
There are many signs and symptoms of Cholestasis. The first and most common sign is typically the intense itching (with or without a rash) which often leaves women unable to sleep. I also experience upper right quadrant pain which radiates behind my rib cage, right below my shoulder blade. This pain is persistent, but seems to get worse when I am executing myself. The other symptom I have (that is probably the worst for me) is unexplained exhaustion. This fatigue goes above anything I experienced during my first pregnancy. It makes me cringe at the thought of walking up the stairs and tire sweeping the house. It is worsened with my lack of appetite and nausea that has returned with a vengeance (also a symptom of ICP!). Other symptoms include: dark urine, pale stool, mild depression, pre-term labour and jaundice.
What is the risk? Aside from feeling like garbage, ICP poses risks to your baby:
Pre-term labor/delivery
Fetal Distress
Meconium Passage
Respiratory distress syndrome (RDS)
Failure to establish breathing (sometimes called fetal asphyxia)
Maternal hemorrhage
Stillbirth (Intrauterine Fetal Demise/IUFD)
Due to my pregnancy now being classified as "high risk," my care was immediately transferred from a midwife to an OB. I was lucky enough to be offered a "shared care" model, where I am able to see both medical professionals and have both professionals at the labour and delivery.
What can I do to prevent the risks mentioned above? Unfortunately, not a lot. I was prescribed a medication called Ursoidol as soon as I was diagnosed. My OB stated that the medication would solely treat the symptoms of ICP (primarily the itching) and would not have an effect on the bile salt levels. On the other hand, my midwife indicated that the medication could in fact maintain/reduce the bile salt levels but suggested that there wasn't a lot of research to support this. (Yes, there is a lot of misinformation out there). I will be induced early between 36-37 weeks as the risk for having a stillborn baby increases 3X after 37 weeks (according to my medical team).
In the meantime, I am trying to get as much rest as possible to avoid feeling exhausted. And, although the last thing I want to do is eat, I force myself to do so every few hours. It's important to note that every single person is effected by ICP differently. Your bile salt levels will differ and your symptoms may not be the same BUT, the risk is there. In addition, your medical team may suggest a different form of treatment and that's okay! Please ensure you are following your teams instructions while staying informed.
If you're looking for support, I found a great Facebook group called ICP Care/Itchy Moms that is a beautifully supportive and informative group of women who are ALL going through something very similar. Copy and paste the link below to join!
https://www.facebook.com/groups/ICPCare/
For more information on Cholestais/ICP please visit www.icpcare.org (or click on the picture above) and don't forget to check back for an update on my own pregnancy journey with Cholestasis/ICP.