ICD-10: O26.64

Intrahepatic cholestasis of pregnancy (ICP) is a liver disorder that occurs during pregnancy, characterized by the impairment of bile flow, leading to the accumulation of bile acids in the liver and bloodstream. The ICD-10 code O26.64 specifically refers to this condition, providing a standardized classification for medical documentation and billing purposes.

Clinical Description of Intrahepatic Cholestasis of Pregnancy

Definition and Pathophysiology

Intrahepatic cholestasis of pregnancy is defined as a reversible liver condition that typically arises in the second or third trimester. It is characterized by elevated levels of bile acids in the maternal serum, which can lead to significant maternal and fetal complications. The exact etiology remains unclear, but it is believed to involve genetic, hormonal, and environmental factors that disrupt normal bile acid transport mechanisms in the liver[1][2].

Symptoms

The hallmark symptom of ICP is intense pruritus (itching), often starting on the palms of the hands and soles of the feet, and can be particularly distressing for the patient. Other symptoms may include:
- Jaundice (yellowing of the skin and eyes)
- Dark urine
- Pale stools
- Fatigue

These symptoms can vary in severity and may not be present in all cases[3][4].

Diagnosis

Diagnosis of ICP is primarily based on clinical symptoms and laboratory findings. Key diagnostic criteria include:
- Elevated serum bile acids (typically >10 µmol/L)
- Elevated liver enzymes (alanine aminotransferase [ALT] and aspartate aminotransferase [AST])
- Exclusion of other liver diseases

A thorough history and physical examination are essential, along with appropriate laboratory tests to confirm the diagnosis[5][6].

Management and Treatment

Management of ICP focuses on alleviating symptoms and minimizing risks to the fetus. Treatment options may include:
- Ursodeoxycholic acid (UDCA): This medication is commonly used to reduce bile acid levels and improve liver function.
- Symptomatic relief: Antihistamines may be prescribed to help manage itching.
- Monitoring: Close monitoring of fetal well-being is crucial, often involving regular ultrasounds and non-stress tests to assess fetal health.

In severe cases, early delivery may be considered to prevent complications such as fetal distress or stillbirth, particularly if bile acid levels remain significantly elevated[7][8].

Complications

ICP can lead to several complications for both the mother and the fetus, including:
- Increased risk of preterm labor
- Fetal distress
- Meconium-stained amniotic fluid
- Stillbirth, particularly in cases with very high bile acid levels

The risk of these complications underscores the importance of early diagnosis and management of the condition[9][10].

Conclusion

Intrahepatic cholestasis of pregnancy, classified under ICD-10 code O26.64, is a significant condition that requires careful monitoring and management to ensure the health and safety of both the mother and the fetus. Understanding the clinical presentation, diagnostic criteria, and treatment options is essential for healthcare providers to effectively address this disorder during pregnancy. Regular follow-up and a multidisciplinary approach can help mitigate risks and improve outcomes for affected individuals.

Intrahepatic cholestasis of pregnancy (ICP), classified under ICD-10 code O26.64, is a liver disorder that occurs during pregnancy, characterized by impaired bile flow. This condition can lead to significant maternal and fetal complications, making its recognition and management crucial. Below is a detailed overview of the clinical presentation, signs, symptoms, and patient characteristics associated with ICP.

Clinical Presentation

Signs and Symptoms

1. Pruritus:
   - The most common symptom of ICP is intense itching, particularly on the palms of the hands and soles of the feet. This itching often worsens at night and can be distressing for the patient[1][5].

2. Jaundice:
   - Some patients may develop jaundice, which is characterized by yellowing of the skin and eyes. This occurs due to the accumulation of bile acids in the bloodstream[1][4].

3. Fatigue:
   - Many women report increased fatigue, which can be attributed to the discomfort caused by itching and the overall stress of the condition[1][3].

4. Dark Urine and Pale Stools:
   - Patients may notice dark-colored urine and pale stools, which are indicative of bile flow obstruction[1][4].

5. Nausea and Vomiting:
   - Some women may experience gastrointestinal symptoms such as nausea and vomiting, although these are less common compared to pruritus[1][3].

Patient Characteristics

1. Demographics:
   - ICP typically occurs in the third trimester of pregnancy, although it can manifest earlier. It is more prevalent in women with a history of the condition in previous pregnancies or those with a family history of liver disease[2][5].

2. Risk Factors:
   - Certain factors increase the likelihood of developing ICP, including:

   • Multiple gestations (twins or more)
   • Previous episodes of ICP
   • Personal or family history of liver disease
   • Ethnicity, with higher incidence reported in women of Scandinavian descent[2][3][5].

3. Associated Conditions:
   - Women with ICP may also have other pregnancy-related complications, such as gestational diabetes or preeclampsia, although these associations can vary[1][4].

Diagnosis and Management

Diagnostic Criteria

Diagnosis of ICP is primarily clinical, supported by laboratory tests that show elevated serum bile acids and liver enzymes. The presence of pruritus, particularly in the absence of a rash, is a key diagnostic criterion[1][3].

Management Strategies

Management of ICP focuses on alleviating symptoms and minimizing risks to the fetus. This may include:
- Ursodeoxycholic Acid: This medication is often prescribed to help reduce bile acid levels and alleviate itching[1][4].
- Monitoring: Regular fetal monitoring is essential to assess fetal well-being, as ICP is associated with increased risks of preterm birth and fetal distress[1][5].
- Delivery Planning: In many cases, early delivery may be recommended, especially if bile acid levels are significantly elevated or if there are signs of fetal distress[1][4].

Conclusion

Intrahepatic cholestasis of pregnancy is a significant condition that requires careful monitoring and management to ensure the health of both the mother and the fetus. Recognizing the clinical signs and symptoms, understanding patient characteristics, and implementing appropriate management strategies are essential for optimal outcomes. If you suspect ICP, it is crucial to consult a healthcare provider for further evaluation and treatment.

Intrahepatic cholestasis of pregnancy (ICP) is a liver condition that occurs during pregnancy, characterized by impaired bile flow and elevated bile acids in the bloodstream. The ICD-10 code O26.64 specifically refers to this condition. Here are some alternative names and related terms associated with this diagnosis:

Alternative Names for Intrahepatic Cholestasis of Pregnancy

1. Cholestasis of Pregnancy: This term is often used interchangeably with intrahepatic cholestasis of pregnancy, emphasizing the condition's occurrence during pregnancy.

2. Pregnancy-Associated Cholestasis: This name highlights the association of the cholestatic condition specifically with the pregnant state.

3. Obstetric Cholestasis: This term is used in some medical literature to refer to cholestasis that occurs in pregnant women, focusing on its obstetric implications.

4. Intrahepatic Cholestasis: While this term can refer to cholestasis occurring outside of pregnancy, it is frequently used in the context of ICP when discussing liver function and bile flow issues.

Related Terms

1. Bile Acid Malabsorption: This term refers to the impaired absorption of bile acids, which can be a feature of cholestatic conditions, including ICP.

2. Pruritus Gravidarum: This term describes the intense itching that often accompanies intrahepatic cholestasis of pregnancy, which is one of the hallmark symptoms of the condition.

3. Hepatic Dysfunction in Pregnancy: This broader term encompasses various liver-related issues that can arise during pregnancy, including ICP.

4. Cholestatic Liver Disease: This term refers to a group of liver diseases characterized by cholestasis, which can include ICP among other conditions.

5. Gestational Cholestasis: Similar to pregnancy-associated cholestasis, this term emphasizes the timing of the condition during gestation.

Understanding these alternative names and related terms can help in recognizing and discussing intrahepatic cholestasis of pregnancy in both clinical and educational contexts. Each term may be used in different medical literature or discussions, but they all relate back to the same underlying condition characterized by impaired bile flow during pregnancy.

Intrahepatic cholestasis of pregnancy (ICP) is a liver disorder that occurs during pregnancy, characterized by impaired bile flow and elevated bile acids in the bloodstream. The ICD-10 code O26.64 specifically refers to this condition. The diagnosis of ICP involves several criteria, which can be summarized as follows:

Clinical Criteria for Diagnosis

1. Symptoms

• Pruritus: The most common symptom is intense itching, particularly on the palms of the hands and soles of the feet, which often worsens at night.
• Jaundice: Some women may develop jaundice, which is a yellowing of the skin and eyes, although this is less common.

2. Laboratory Tests

• Elevated Bile Acids: A key diagnostic criterion is the measurement of serum bile acids. Levels greater than 10 µmol/L are typically indicative of cholestasis.
• Liver Function Tests: Abnormal liver function tests, including elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST), may also be present, although they are not always elevated in ICP.

3. Exclusion of Other Conditions

• It is essential to rule out other causes of liver dysfunction and pruritus during pregnancy, such as:
  • Hepatitis (viral or autoimmune)
  • Drug-induced liver injury
  • Other cholestatic liver diseases

4. Timing of Symptoms

• Symptoms typically arise in the third trimester, although they can occur earlier in some cases. The timing of symptom onset is an important factor in the diagnosis.

5. Response to Treatment

• Improvement of symptoms following treatment with medications such as ursodeoxycholic acid can support the diagnosis of ICP.

Conclusion

The diagnosis of intrahepatic cholestasis of pregnancy (ICD-10 code O26.64) is primarily based on clinical symptoms, laboratory findings, and the exclusion of other liver-related conditions. Elevated bile acids and the characteristic pruritus are central to the diagnosis, with careful monitoring and management being crucial for the health of both the mother and the fetus. If you have further questions or need more detailed information, feel free to ask!

Intrahepatic cholestasis of pregnancy (ICP), classified under ICD-10 code O26.64, is a liver disorder that occurs during pregnancy, characterized by impaired bile flow and elevated bile acids in the bloodstream. This condition can lead to significant maternal and fetal complications, making its management crucial. Below, we explore the standard treatment approaches for ICP.

Understanding Intrahepatic Cholestasis of Pregnancy

ICP typically manifests in the third trimester and is marked by symptoms such as intense itching, particularly on the palms and soles, and elevated liver enzymes and bile acids. The exact cause of ICP is not fully understood, but it is believed to involve genetic, hormonal, and environmental factors. The condition is associated with an increased risk of preterm birth, fetal distress, and stillbirth, necessitating careful monitoring and management[1][2].

Standard Treatment Approaches

1. Symptomatic Relief

The primary goal in managing ICP is to alleviate symptoms and minimize risks to both the mother and the fetus. Common symptomatic treatments include:

• Antihistamines: Medications such as diphenhydramine may be prescribed to help relieve itching, although their effectiveness can vary[3].
• Topical Treatments: Calamine lotion or other soothing creams can provide temporary relief from itching[3].

2. Ursodeoxycholic Acid (UDCA)

UDCA is the most commonly used medication for treating ICP. It helps to reduce bile acid levels in the blood and improve liver function. Studies have shown that UDCA can alleviate pruritus (itching) and may also reduce the risk of adverse fetal outcomes[4][5]. The typical dosage is 10-15 mg/kg/day, divided into two or three doses, and treatment is usually continued until delivery[4].

3. Monitoring and Management of Fetal Well-being

Regular monitoring of fetal well-being is essential in managing ICP. This includes:

• Non-Stress Tests (NST): These tests assess fetal heart rate and can help identify any signs of fetal distress.
• Ultrasound: Regular ultrasounds may be performed to monitor fetal growth and amniotic fluid levels[6].
• Biophysical Profile (BPP): This combines an ultrasound evaluation with a non-stress test to assess the fetus's health.

4. Delivery Planning

In cases of severe ICP or when bile acid levels are significantly elevated, early delivery may be considered to reduce risks to the fetus. The timing of delivery is typically around 37-38 weeks of gestation, depending on the severity of the condition and the fetal condition[7].

5. Postpartum Care

After delivery, most women experience a rapid resolution of symptoms, and bile acid levels typically return to normal. However, it is important to monitor liver function and educate women about the potential for recurrence in future pregnancies[8].

Conclusion

The management of intrahepatic cholestasis of pregnancy involves a combination of symptomatic treatment, medication, and careful monitoring of both maternal and fetal health. Ursodeoxycholic acid remains the cornerstone of pharmacological therapy, while regular fetal assessments are crucial to ensure a safe pregnancy outcome. Given the potential complications associated with ICP, a multidisciplinary approach involving obstetricians, hepatologists, and pediatricians is often beneficial to optimize care for both mother and child.

For women with a history of ICP, discussing future pregnancy plans with healthcare providers is essential to ensure appropriate monitoring and management strategies are in place.