Background Information

ICP Severity

Guidelines

Maternal and Perinatal Risks

Maternal Risks

The predominant impact on the mother is itching, which can be severe and may affect sleep​​​​​​

There is also an increased risk of developing:

• Pre-eclampsia
• Gestational diabetes

Perinatal Risks

Increased risk of:

• Stillbirth (if severe ICP – peak bile acid >100 mmol/L)
  • If bile acid is mildly / moderately elevated (<100 mmol/L), the risk is similar to those without ICP

• Preterm birth
• Meconium-stained amniotic fluid
• Receiving neonatal care

Investigation and Diagnosis

There is no single diagnostic test for ICP.

RCOG recommends considering ICP if:

• Itching with normal skin appearance, AND
• ↑ Peak random total bile acid concentration (>19 mmol/L)

The diagnosis is more likely if the itching and raised bile acids resolve after birth.

RCOG: “Additional laboratory and/or imaging investigations are not recommended in every woman, but could be considered on an individual basis.”

Management

Advise women that there is no available treatment to improve pregnancy outcome

Pharmacological Management

Consider the following to reduce itching:

• Topical emolients
• Anti-histamines (e.g. chlorphenamine)

Only consider vitamin K if there is:

• Evidence of reduced dietary fat absorption (e.g. steatorrhoea) AND/OR
• Abnormal prothrombin time

Do NOT routinely offer ursodeoxycholic acid (as there is no evidence of significant benefit).

Timing of Birth

The timing of birth largely depends on the severity of ICP:

Mode of Birth

ICP on its own does NOT determine the mode of birth (i.e., either induction of labour or C/S can be done)

References

Original Guideline