ICD-10: O26.642

Intrahepatic cholestasis of pregnancy (ICP) is a liver disorder that occurs during pregnancy, characterized by the accumulation of bile acids in the liver, leading to their release into the bloodstream. This condition typically manifests in the third trimester but can also occur in the second trimester, as indicated by the ICD-10 code O26.642.

Clinical Description of Intrahepatic Cholestasis of Pregnancy

Symptoms and Diagnosis

The primary symptoms of ICP include:

• Pruritus: Intense itching, particularly on the palms of the hands and soles of the feet, which can be severe and distressing.
• Jaundice: Yellowing of the skin and eyes may occur in some cases, although it is less common.
• Dark Urine and Pale Stools: Changes in urine and stool color can indicate bile acid accumulation.

Diagnosis is typically made based on clinical symptoms, liver function tests, and bile acid levels. Elevated serum bile acids are a hallmark of the condition, often exceeding 10 µmol/L, and liver enzymes may also be elevated.

Risk Factors

Several factors may increase the risk of developing ICP, including:

• Previous History: Women who have had ICP in previous pregnancies are at a higher risk.
• Family History: A family history of liver disease or cholestasis can predispose individuals to this condition.
• Multiple Pregnancies: Women carrying multiples (twins or more) are at increased risk.

Complications

ICP can lead to several complications for both the mother and the fetus, including:

• Preterm Birth: Increased risk of delivering before term.
• Fetal Distress: Potential for fetal heart rate abnormalities due to bile acid toxicity.
• Stillbirth: There is an increased risk of stillbirth, particularly in severe cases of ICP.

ICD-10 Code O26.642

The ICD-10 code O26.642 specifically refers to "Intrahepatic cholestasis of pregnancy, second trimester." This code falls under the broader category of maternal care for other conditions predominantly related to pregnancy (Group O26).

Coding Details

• Code Structure: O26.642 is part of the O26 category, which encompasses various maternal care conditions. The specific code indicates the timing of the condition (second trimester) and the nature of the disorder (intrahepatic cholestasis).
• Clinical Use: This code is used for billing and documentation purposes in healthcare settings, ensuring that the condition is accurately recorded in medical records and insurance claims.

Management

Management of ICP typically involves:

• Monitoring: Regular monitoring of liver function and bile acid levels.
• Medications: Ursodeoxycholic acid is commonly prescribed to help reduce bile acid levels and alleviate itching.
• Delivery Planning: Depending on the severity of the condition and gestational age, early delivery may be considered to reduce risks to the fetus.

Conclusion

Intrahepatic cholestasis of pregnancy, particularly in the second trimester as denoted by ICD-10 code O26.642, is a significant condition that requires careful monitoring and management to mitigate risks to both the mother and the fetus. Understanding the symptoms, risks, and management strategies is crucial for healthcare providers to ensure optimal outcomes for pregnant individuals experiencing this disorder.

Intrahepatic cholestasis of pregnancy (ICP) is a liver disorder that can occur during pregnancy, particularly affecting the second trimester. The ICD-10 code O26.642 specifically refers to this condition when it arises during the second trimester. Here are some alternative names and related terms associated with this diagnosis:

Alternative Names for Intrahepatic Cholestasis of Pregnancy

1. Cholestasis of Pregnancy: This is a broader term that encompasses all forms of cholestasis occurring during pregnancy, not limited to the intrahepatic type.
2. Pregnancy-Associated Cholestasis: This term highlights the association of cholestasis with pregnancy, indicating that it is a condition that arises specifically during this period.
3. Intrahepatic Cholestasis: While this term can refer to the condition outside of pregnancy, it is often used interchangeably in the context of pregnancy-related issues.
4. Obstetric Cholestasis: This term is sometimes used to describe cholestasis that occurs specifically in pregnant women, emphasizing its obstetric context.

Related Terms

1. Pruritus Gravidarum: This term refers to the intense itching that often accompanies intrahepatic cholestasis of pregnancy, which is one of the hallmark symptoms of the condition.
2. Liver Dysfunction in Pregnancy: A broader category that includes various liver-related issues that can occur during pregnancy, including ICP.
3. Cholestatic Liver Disease: This term encompasses a range of liver diseases characterized by impaired bile flow, which can include ICP.
4. Second Trimester Liver Disease: A general term that may refer to any liver-related condition that arises during the second trimester of pregnancy, including intrahepatic cholestasis.

Clinical Context

Intrahepatic cholestasis of pregnancy is characterized by elevated bile acids in the maternal serum, leading to symptoms such as severe itching, particularly on the palms and soles. It is important to monitor and manage this condition due to potential risks to both the mother and the fetus, including preterm birth and fetal distress.

Understanding these alternative names and related terms can aid healthcare professionals in accurately diagnosing and discussing the condition, ensuring appropriate care and management for affected individuals.

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 O26.642 specifically refers to ICP occurring in the second trimester of pregnancy. The diagnosis of this condition involves several criteria, which are essential for accurate coding and management.

Diagnostic Criteria for Intrahepatic Cholestasis of Pregnancy

Clinical Symptoms

1. Pruritus: The most common symptom of ICP is intense itching, particularly on the palms of the hands and soles of the feet, which may worsen at night. This itching is often the first sign prompting further investigation.
2. Jaundice: Although not always present, jaundice (yellowing of the skin and eyes) can occur in more severe cases of ICP. The presence of jaundice can help differentiate ICP from other causes of pruritus in pregnancy.

Laboratory Findings

1. Elevated Bile Acids: A key diagnostic criterion is the measurement of serum bile acids. Levels greater than 10 µmol/L are typically indicative of ICP. This test is crucial as it reflects the liver's ability to excrete bile.
2. Liver Function Tests: Abnormal liver function tests, including elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST), may also be observed. However, these tests are not always elevated in ICP.

Exclusion of Other Conditions

1. Ruling Out Other Causes: It is essential to exclude other potential causes of pruritus and liver dysfunction during pregnancy, such as:
   - Hepatitis (viral or autoimmune)
   - Cholestasis due to other medical conditions
   - Dermatitis or other skin conditions

Timing of Symptoms

1. Gestational Age: For the diagnosis of O26.642, symptoms must occur during the second trimester (weeks 13 to 27 of gestation). The timing is critical for accurate coding and management.

Response to Treatment

1. Symptom Relief: Patients often experience relief from symptoms with treatment, which may include medications such as ursodeoxycholic acid. A positive response can support the diagnosis of ICP.

Conclusion

The diagnosis of intrahepatic cholestasis of pregnancy, particularly for the ICD-10 code O26.642, relies on a combination of clinical symptoms, laboratory findings, and the exclusion of other conditions. The presence of pruritus, elevated bile acids, and the timing of symptoms during the second trimester are key components in establishing this diagnosis. Proper identification and management are crucial, as ICP can have implications for both maternal and fetal health, including an increased risk of preterm delivery and fetal distress.

Intrahepatic cholestasis of pregnancy (ICP) is a liver disorder that occurs during pregnancy, characterized by impaired bile flow and elevated bile acids in the maternal bloodstream. The ICD-10 code O26.642 specifically refers to ICP occurring in the second trimester. Understanding the clinical presentation, signs, symptoms, and patient characteristics associated with this condition is crucial for timely diagnosis and management.

Clinical Presentation

Signs and Symptoms

The clinical presentation of intrahepatic cholestasis of pregnancy typically includes the following signs and symptoms:

• Pruritus: The most common symptom, characterized by 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[6].
• Jaundice: Although not always present, some patients may exhibit jaundice, which is a yellowing of the skin and eyes due to elevated bilirubin levels[6].
• Dark Urine: Patients may notice darker urine, which can be a result of increased bilirubin excretion[6].
• Pale Stools: Stools may appear lighter in color due to reduced bile flow into the intestines[6].
• Fatigue: Generalized fatigue and malaise are common complaints among affected individuals[6].

Timing and Duration

Intrahepatic cholestasis of pregnancy typically manifests in the second or third trimester, with the second trimester being the focus for the ICD-10 code O26.642. Symptoms may begin as early as the 20th week of gestation and can persist until delivery, although they often resolve shortly after childbirth[8].

Patient Characteristics

Demographics

Certain demographic factors may influence the likelihood of developing ICP:

• Age: Women in their late 20s to early 30s are more frequently affected[8].
• Ethnicity: There is a higher prevalence of ICP among women of South Asian, Hispanic, and Scandinavian descent[8].
• Obesity: Increased body mass index (BMI) is associated with a higher risk of developing ICP[8].

Medical History

Patients with a history of liver disease or a family history of cholestasis may be at increased risk. Additionally, women who have had ICP in previous pregnancies are more likely to experience it again in subsequent pregnancies[8].

Other Risk Factors

• Multiple Gestations: Women carrying twins or more are at a higher risk of developing ICP[8].
• Hormonal Factors: The condition is thought to be influenced by hormonal changes during pregnancy, particularly elevated estrogen levels, which may affect bile acid metabolism[6][8].

Conclusion

Intrahepatic cholestasis of pregnancy, particularly in the second trimester as denoted by ICD-10 code O26.642, presents primarily with pruritus and may include jaundice and changes in urine and stool color. Understanding the signs, symptoms, and patient characteristics associated with this condition is essential for healthcare providers to ensure appropriate monitoring and management, ultimately improving maternal and fetal outcomes. Early recognition and intervention can help mitigate potential complications, such as preterm labor and fetal distress, associated with elevated bile acids during pregnancy[8].

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 condition can lead to significant maternal and fetal complications, making its management crucial, especially during the second trimester, as indicated by the ICD-10 code O26.642.

Overview of Intrahepatic Cholestasis of Pregnancy

ICP typically manifests with symptoms such as intense itching, particularly on the palms and soles, and may be accompanied by jaundice. The exact cause of ICP is not fully understood, but it is believed to involve hormonal and genetic factors that affect bile acid metabolism during pregnancy[1][2].

Standard Treatment Approaches

1. Symptomatic Relief

• Antihistamines: Medications such as diphenhydramine may be prescribed to alleviate itching, although they do not address the underlying bile acid elevation[3].
• Topical Treatments: Emollients and cooling lotions can provide temporary relief from pruritus (itching) associated with ICP[4].

2. Bile Acid Sequestrants

• Ursodeoxycholic Acid (UDCA): This medication is commonly used to reduce bile acid levels and improve liver function. UDCA has been shown to alleviate symptoms and may help in reducing the risk of fetal complications[5][6]. The typical dosage is 10-15 mg/kg/day, divided into two or three doses.

3. Monitoring and Management of Complications

• Regular Fetal Monitoring: Due to the increased risk of fetal distress and preterm birth associated with ICP, regular monitoring through non-stress tests (NST) and biophysical profiles (BPP) is recommended[7].
• Liver Function Tests: Frequent assessments of liver function and bile acid levels are essential to monitor the progression of the disease and the effectiveness of treatment[8].

4. Delivery Considerations

• Timing of Delivery: In cases of severe ICP or when bile acid levels exceed certain thresholds (often >40 µmol/L), early delivery may be considered, typically around 37 weeks of gestation, to minimize risks to the fetus[9][10]. The decision should be made collaboratively by the obstetrician and the patient, considering the severity of symptoms and fetal well-being.

5. Postpartum Care

• Follow-Up: Women with a history of ICP should be monitored postpartum, as the condition can recur in subsequent pregnancies. Additionally, liver function tests may be warranted to ensure recovery[11].

Conclusion

The management of intrahepatic cholestasis of pregnancy, particularly in the second trimester, involves a combination of symptomatic treatment, monitoring, and potential early delivery to safeguard maternal and fetal health. The use of UDCA has become a cornerstone in the treatment of ICP, providing both symptomatic relief and a reduction in complications. Continuous collaboration between the patient and healthcare providers is essential for optimal outcomes.

For further information or specific case management, consulting with a specialist in maternal-fetal medicine is advisable.