Friday, April 17, 2009

Let the Complications Begin

Today was my second appoinment with the wonderful Dr. S, my OB/GYN. The good news from the appointment is thatso far it doesn''t appear I am developing gestational diabetes again, and I am also now feeling her kick more strongly and more frequently, all great things. But...after my last appointment at 10 weeks he ordered a bile salts test, to get a baseline to compare against later on in case I began developing symptoms of Intrahepatic Cholestasis of Pregnancy, which is a liver condition that I had during my pregnancy with Joey. As it turns out he won't be getting a baseline, because the values are already substantially elevated, indicating that it has already started with this pregnancy. It's relatively early for this to have started already which can indicate that it will develop more seriously as well.

In case you don''t know what ICP is, here is the description according to the March of Dimes:


What is ICP?

ICP is a pregnancy-related liver disorder in which there are abnormalities in the flow of bile (a substance produced by the liver that aids in the digestion and absorption of fats). These abnormalities lead to a build-up of bile acids (components of bile) in the mother's blood, resulting in symptoms such as severe skin itching.

What are the symptoms of ICP?

The symptoms of ICP can range from mild to severe. Symptoms usually start in the second or third trimester of pregnancy. The most common symptoms include:

Skin itching: Itching often is most severe on the palms of the hands and soles of the feet, but many affected women itch all over their bodies. It often gets progressively worse and may interfere with sleep and daily activities.

Jaundice: This yellowing of the skin and whites of the eyes occurs in 10 to 20 percent of women with ICP. Jaundice is caused by a build-up of a chemical called bilirubin in the blood, resulting from the liver disorder and decreased bile flow.
A pregnant woman should call her health care provider if she has these symptoms.

How common is ICP?

In the United States, ICP affects less than 1 percent of women.

What are the risks of ICP in pregnancy?

ICP can be very uncomfortable for the pregnant woman. It also can hurt the baby. Up to 60 percent of women with ICP deliver prematurely (before 37 completed weeks of pregnancy). Premature babies are at increased risk for health problems during the newborn period and for lasting disabilities and death. ICP also increases the risk for stillbirth, though the risk is small (1 to 2 percent). It is important to diagnose and treat ICP to help prevent these potential problems.

How is ICP diagnosed?

There are a number of skin disorders of pregnancy that can cause itching; most do not harm the mother or baby. Blood tests can tell if a woman's itching is due to ICP. These often include a blood test that measures various chemicals that show how well a woman's liver is functioning and the amount of bile acids in her blood.

How is ICP treated?

ICP often is treated with a medication called ursodeoxycholic acid (Actigall). This medication relieves skin itching, helps correct liver function abnormalities and may help prevent stillbirth.

The health care provider monitors the baby closely (with ultrasound and tests that measure heart rate) to see if the baby appears to be developing any difficulties, such as heart rate abnormalities, due to ICP. If the baby is having difficulties, the provider may recommend early delivery to help reduce the risk of stillbirth. The provider also may do a test called amniocentesis when the baby is at about 36 weeks gestation to see if the lungs are mature. If the baby's lungs are mature enough for the baby to breathe on his own, the provider may induce labor at 36 to 38 weeks to help prevent stillbirth.

What causes ICP?

The cause of ICP is not well understood. Pregnancy hormones and heredity appear to play a role. ICP appears to be more common in twin (or other multiple) pregnancies, possibly due to increased hormone levels. About half of women with ICP have a family history of related liver disorders.

Does ICP go away after delivery?

Symptoms of ICP generally clear up on their own by about two days after delivery. However, about 60 to 70 percent of affected women develop ICP again in another pregnancy.

Doesn't that all sound so pleasant? The symptoms in my pregnancy with Joey weren't really noticeable until I was about 6.5 months along. It''s also very likely that ICP is wha caused Joey to be born a month early...I was scheduled to be induced at 37 weeks due to the ICP but Joey came on his own at 35 weeks 6 days. This time is a bit different...I started feeling itchy about 2 weeks ago but said nothing to anyone, I really believed I was being paranoid and imagining things. With me it also doesn't start on the soles of my feet and palms of my hands, which is the most typical. I started feeling my back get itchy (not fun when no one is around to scratch for me!) and the front of my calfs.

So today I started the medication, which will hopefully bring my bile salt levels in my blood down to a safe level for both the baby and myself. It should also stop the incredibly annoying itching, or at least make it more manageable I hope. In the meantime Dr. S. wants me to meet with a specialist at Mount Sinai Hospital in Toronto within the next 2 weeks for further advice on treatment.

Despite receiving this bad news today I am still so happy tonight, since our sweet baby Joey will be returning from Florida tomorrow! Jason and I have missed him terribly and we can't wait to see him. Unfortunately for him the vacation ends pretty abruptly over the upcoming week, he has an appointment with the pediatrician on Wednesday and a dentist appointment on Thursday, along with all the work he has to catch up on with his physiotherapy and walker class. Poor kid, he's more schedued than we are :)

- P, J & J


catherinejar said...

Hello Pam,
I found your blog through an internet search for ICP Toronto. I hope you don't mind me contacting you. How touching and real you are! Your journey with Joey is courageous and beautiful, and how strong you have become!

The reason I am contacting you is because I believe I have ICP for the 2nd time around, and I wanted to ask you about the specialist that you refer to in your post at Mt Sinai?

I have a great doctor but who knows nothing about ICP and doesn't have the ability to order a serum bile acid test nor does she know what dosage of Urso to prescribe. Could you please let me know who your doctor is so I could ask her to get a referral?

I am in Toronto as well. Thank you so much and blessings to you and your family.

Pamela, Jason and Joey said...

Hi Catherine,

I have no other way of contacting you (you didn''t give me an email addy!)so I''m hoping you''ll see this response.

I see Dr. Ritchie at Mt. Sinai, who has loads of experience in ICP. He's part of the Special Pregnancy Program there (basically for high risk pregnancies),by referral only. I'm not sure if ICP alone qualifies as a high-risk but it's worth a try! I have a history of other complications (gestational diabetes, premature labour and my first child is disabled) so I definitely qualified as high risk.

If you're still seeing your GP I would ask for a referral to an OB right away instead of waiting until 28 weeks (I'm not sure what is standard practice in TO but in Barrie we don't get referred to an OB until 28 weeks because of the lack of OBs here). I also know that a bile acid test is $40 if done at a regular lab, I'm not sure why it's not covered under OHIP. The only place I've had the test done and not had to pay was at Mt. Sinai since they do them right there in the hospital.

Good luck, and feel free to email me if you have any more questions...