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IHCP

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What does IHCP refer to in your context? It can have different meanings, such as an international healthcare professional or a healthcare program.

I mean, Intra hepatic cholestasis of pregnancy

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"Intrahepatic Cholestasis" AND pregnancy

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intrahepatic cholestasis pregnancy diagnosis management bile acids guideline

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https://publications.smfm.org/publications/374-society-for-m…

Intrahepatic cholestasis of pregnancy (IHCP/ICP) is a liver disorder that usually occurs in the second or third trimester. It causes impaired bile flow and raised maternal serum bile acids. It typically resolves after birth.

Typical presentation

  • Intense itching without a primary rash, often worse at night
  • Itching commonly affects the palms and soles, but can be generalized
  • Scratch marks may be present
  • Occasionally dark urine, pale stools, or jaundice

Diagnosis

Diagnosis is based on compatible itching plus elevated total serum bile acids, after excluding other causes of liver disease or itching. Liver transaminases may also rise. Some guidelines use a bile-acid threshold of ≥19 micromol/L, while older references commonly use >10 micromol/L. Repeat testing is appropriate if symptoms persist but the first result is normal.
  • Creasy & Resnik’s Maternal-Fetal Medicine, p. 1001
  • The SMFM guidance recommends measuring serum bile acids and liver transaminases when ICP is suspected.

Why it matters

Maternal prognosis is usually good, but the fetus has increased risk of:
  • Spontaneous preterm birth
  • Meconium-stained liquor
  • Fetal distress
  • Stillbirth, particularly with peak bile acids ≥100 micromol/L
Severity is commonly grouped as:
  • Mild: 19-39 micromol/L
  • Moderate: 40-99 micromol/L
  • Severe: ≥100 micromol/L, associated with the highest stillbirth risk
This risk stratification is reflected in the RCOG guideline.

Management

Management should be coordinated by an obstetric team or maternal-fetal medicine specialist and includes:
  1. Serial bile-acid levels and liver-function tests
  2. Ursodeoxycholic acid (UDCA) for maternal itching. It can improve symptoms and biochemical tests, but should not be considered proven protection against stillbirth.
  3. Fetal surveillance when delivery would be undertaken for an abnormal result. A normal CTG/NST does not reliably eliminate sudden stillbirth risk.
  4. Planned delivery based chiefly on peak bile acids and obstetric context. SMFM recommends:
    • ≥100 micromol/L: offer delivery at 36+0 weeks
    • <100 micromol/L: delivery between 36+0 and 39+0 weeks, individualized
      The SMFM recommendations also advise against preterm delivery before 37 weeks without laboratory confirmation of raised bile acids.

After delivery

  • Itching and laboratory abnormalities should resolve, generally within days to weeks.
  • Repeat liver tests and bile acids are needed postpartum to confirm resolution.
  • ICP frequently recurs in later pregnancies.
  • Persistently abnormal results require evaluation for another liver or biliary disorder.
Seek urgent obstetric assessment today for reduced fetal movements, vaginal bleeding, contractions, jaundice, severe right-upper-abdominal pain, or severe itching in pregnancy.
Recent evidence continues to support the association between ICP severity and adverse perinatal outcomes, including a 2024 systematic review and meta-analysis (PMID 38750666).
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