ICD-10: O26.643

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 O26.643 specifically refers to ICP occurring in the third trimester of pregnancy. Below is a detailed clinical description and relevant information regarding this condition.

Clinical Description of Intrahepatic Cholestasis of Pregnancy

Definition and Pathophysiology

Intrahepatic cholestasis of pregnancy is a condition that primarily affects the liver's ability to excrete bile, leading to the accumulation of bile acids in the maternal bloodstream. This condition is thought to be related to hormonal changes during pregnancy, particularly the increased levels of estrogen and progesterone, which can affect liver function and bile production. The exact mechanism remains unclear, but genetic predisposition and environmental factors may also play a role in its development[2][6].

Symptoms

The hallmark symptom of ICP is intense itching (pruritus), which often begins on the palms of the hands and soles of the feet and can spread to other areas of the body. This itching is typically worse at night and can be quite distressing for the affected individual. Other symptoms may include:

• Dark urine
• Pale stools
• Fatigue
• Jaundice (in some cases)

It is important to note that jaundice is less common in ICP compared to other liver diseases[3][6].

Diagnosis

Diagnosis of ICP is primarily based on clinical symptoms and laboratory tests. Key diagnostic criteria include:

• Elevated serum bile acids (usually >10 µmol/L)
• Elevated liver enzymes (ALT and AST)
• Exclusion of other liver diseases

The diagnosis is often confirmed in the third trimester, as symptoms typically manifest during this period, although they can occur earlier in pregnancy[1][4].

Risk Factors

Several risk factors have been identified for developing ICP, including:

• Previous history of ICP in a prior pregnancy
• Family history of liver disease
• Multiple gestations (twins or more)
• Maternal age over 35
• Certain ethnic backgrounds, with higher prevalence in women of Scandinavian descent[3][7].

Management and Treatment

Management of ICP focuses on alleviating symptoms and minimizing risks to both the mother and the fetus. Treatment options may include:

• Ursodeoxycholic acid (UDCA): This medication is commonly prescribed to help reduce bile acid levels and alleviate itching.
• Antihistamines: These may provide symptomatic relief for itching.
• Monitoring: Regular monitoring of liver function tests and fetal well-being is essential, as ICP can increase the risk of complications such as preterm birth and fetal distress.

In some cases, early delivery may be recommended if the condition is severe or if there are signs of fetal distress[5][6].

Prognosis

The prognosis for women with ICP is generally good, especially with appropriate management. However, there is an increased risk of complications, including preterm labor, fetal distress, and stillbirth, particularly if bile acid levels are significantly elevated. Close monitoring and timely intervention are crucial to ensure the health of both the mother and the baby[2][4].

Conclusion

Intrahepatic cholestasis of pregnancy, particularly in the third trimester, is a significant condition that requires careful management to mitigate risks to both the mother and the fetus. Understanding the symptoms, diagnosis, and treatment options is essential for healthcare providers to ensure optimal outcomes for affected individuals. If you suspect ICP, it is vital to seek medical attention promptly for appropriate evaluation and management.

Intrahepatic cholestasis of pregnancy (ICP) is a liver disorder that occurs during pregnancy, particularly in the third trimester. It is characterized by the accumulation of bile acids in the liver, leading to various clinical manifestations. The ICD-10 code O26.643 specifically refers to intrahepatic cholestasis of pregnancy occurring in the third trimester. Below is a detailed overview of its clinical presentation, signs, symptoms, and patient characteristics.

Clinical Presentation

Signs and Symptoms

1. Pruritus (Itching):
   - The most common symptom of ICP is intense itching, particularly on the palms of the hands and soles of the feet. This itching can be severe and is often worse at night[1].

2. Jaundice:
   - Some patients may develop jaundice, which is characterized by yellowing of the skin and eyes. This occurs due to elevated levels of bilirubin in the blood, a consequence of impaired bile flow[1][2].

3. Dark Urine and Pale Stools:
   - Patients may notice dark urine and pale-colored stools, which are indicative of bile salt accumulation and reduced bile excretion[2].

4. Fatigue and Malaise:
   - General feelings of tiredness and discomfort are common, often exacerbated by the itching and sleep disturbances caused by it[1].

5. Nausea and Vomiting:
   - Some women may experience gastrointestinal symptoms, including nausea and vomiting, although these are less common than itching and jaundice[2].

Patient Characteristics

1. Demographics:
   - ICP can occur in any pregnant woman, but it is more prevalent in women of certain ethnic backgrounds, particularly those of Scandinavian descent. It is also more common in women with a family history of the condition[3].

2. Obstetric History:
   - Women who have had previous pregnancies complicated by ICP are at a higher risk of recurrence in subsequent pregnancies. Additionally, those with multiple gestations or a history of stillbirth may be more susceptible[3][4].

3. Age and Parity:
   - ICP is often seen in women aged 20-35 years and may be more common in multiparous women (those who have had multiple pregnancies) compared to primiparous women (first-time mothers)[3].

4. Associated Conditions:
   - There is an association between ICP and other conditions such as gestational diabetes and preeclampsia. Women with these conditions may require closer monitoring during pregnancy[4].

Diagnosis and Management

Diagnosis of ICP is typically based on clinical symptoms, particularly the presence of pruritus and elevated bile acids in the blood. Liver function tests may also show abnormalities. Management often involves monitoring the mother and fetus closely, with potential interventions including medication to relieve itching and, in some cases, early delivery to prevent complications such as stillbirth[4][5].

Conclusion

Intrahepatic cholestasis of pregnancy, particularly in the third trimester, presents with distinctive symptoms such as severe itching and jaundice, alongside specific patient characteristics that can help in identifying at-risk individuals. Understanding these clinical presentations is crucial for timely diagnosis and management, ultimately aiming to improve outcomes for both mother and child. If you suspect ICP, it is essential to consult a healthcare provider for appropriate evaluation and care.

Intrahepatic cholestasis of pregnancy (ICP) is a liver condition that can occur during pregnancy, particularly in the third trimester. The ICD-10 code O26.643 specifically refers to this condition. Below are 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 any cholestatic liver condition occurring during pregnancy, not limited to the third trimester.

2. Intrahepatic Cholestasis: This term refers to the condition where bile flow is impaired within the liver, leading to bile accumulation. While it can occur outside of pregnancy, in this context, it specifically relates to pregnancy.

3. Pregnancy-Associated Cholestasis: This term highlights the association of cholestasis with pregnancy, indicating that the condition is triggered or exacerbated by the physiological changes during pregnancy.

4. Obstetric Cholestasis: This term is often used interchangeably with cholestasis of pregnancy and emphasizes its occurrence in the context of obstetrics.

5. Pruritic Intrahepatic Cholestasis of Pregnancy: This name emphasizes one of the hallmark symptoms of the condition, which is intense itching (pruritus) due to bile salt accumulation.

Related Terms

1. Bile Acid Malabsorption: This term refers to the impaired absorption of bile acids, which can be a contributing factor in cholestatic conditions.

2. Liver Dysfunction in Pregnancy: A broader category that includes various liver-related issues that can arise during pregnancy, including ICP.

3. Cholestatic Liver Disease: This term encompasses a range of liver diseases characterized by cholestasis, including those that may occur during pregnancy.

4. Hepatic Impairment in Pregnancy: This term refers to any liver dysfunction that may occur during pregnancy, which can include intrahepatic cholestasis.

5. Third Trimester Liver Disease: This term can refer to any liver-related condition that manifests during the third trimester of pregnancy, including ICP.

Understanding these alternative names and related terms can help in recognizing and discussing the condition more effectively, especially in clinical settings or when researching related literature.

Intrahepatic cholestasis of pregnancy (ICP) is a liver disorder that occurs during pregnancy, particularly in the third trimester, and is characterized by the accumulation of bile acids in the liver. The diagnosis of ICP, specifically for the ICD-10 code O26.643, involves several criteria and considerations.

Diagnostic Criteria for Intrahepatic Cholestasis of Pregnancy

Clinical Symptoms

1. Pruritus: The most common symptom is intense itching, particularly on the palms of the hands and soles of the feet, which may worsen at night.
2. Jaundice: Some women may exhibit jaundice, which is a yellowing of the skin and eyes, although this is less common.
3. Fatigue and Sleep Disturbances: Patients often report fatigue and difficulty sleeping due to itching.

Laboratory Tests

1. Liver Function Tests (LFTs): Elevated levels of liver enzymes (such as alanine aminotransferase [ALT] and aspartate aminotransferase [AST]) are indicative of liver dysfunction.
2. Bile Acids: A significant increase in serum bile acid levels is a hallmark of ICP. Levels above 10 µmol/L are often used as a diagnostic threshold.
3. Other Tests: Tests may also include a complete blood count (CBC) and tests for viral hepatitis to rule out other causes of liver dysfunction.

Timing of Symptoms

• Symptoms typically arise in the third trimester of pregnancy, often after the 30th week, which is a critical factor in diagnosing O26.643.

Exclusion of Other Conditions

• It is essential to exclude other potential causes of pruritus and liver dysfunction, such as:
• Hepatitis (viral or autoimmune)
• Cholestasis due to other medical conditions
• Drug-induced liver injury

Risk Factors

• Certain risk factors may increase the likelihood of developing ICP, including:
• A history of ICP in previous pregnancies
• Family history of liver disease
• Multiple gestations (twins or more)
• Maternal age over 35 years

Conclusion

The diagnosis of intrahepatic cholestasis of pregnancy, particularly for the ICD-10 code O26.643, relies on a combination of clinical symptoms, laboratory findings, and the timing of symptom onset. Elevated bile acids and liver enzymes, along with the exclusion of other liver conditions, are critical for confirming the diagnosis. If you suspect ICP, it is essential to consult a healthcare provider for appropriate testing and management to ensure the health of both the mother and the fetus.

Intrahepatic cholestasis of pregnancy (ICP), particularly in the third trimester, is a liver condition that can significantly impact both maternal and fetal health. The ICD-10 code O26.643 specifically refers to this condition, which is characterized by pruritus (itching) and elevated bile acids due to impaired bile flow. Here’s a detailed overview of standard treatment approaches for managing ICP during pregnancy.

Understanding Intrahepatic Cholestasis of Pregnancy

ICP typically arises in the late stages of pregnancy, often in the third trimester, and is more prevalent in women with a history of the condition or those with a family history of liver disease. The primary symptoms include intense itching, particularly on the palms and soles, and elevated liver enzymes and bile acids, which can pose risks such as preterm birth and fetal distress[1][2].

Standard Treatment Approaches

1. Monitoring and Diagnosis

Early diagnosis is crucial for effective management. This involves:

• Clinical Assessment: Regular monitoring of symptoms, particularly itching and jaundice.
• Laboratory Tests: Blood tests to measure liver function (elevated liver enzymes) and bile acid levels. Elevated bile acids above 10 µmol/L are indicative of ICP[3].

2. Symptomatic Relief

To alleviate itching and discomfort, several symptomatic treatments may be employed:

• Antihistamines: Non-sedating antihistamines can help reduce itching, although their effectiveness may vary.
• Topical Treatments: Emollients and cooling lotions can provide temporary relief from pruritus[4].

3. Medications

The primary pharmacological treatment for ICP includes:

• Ursodeoxycholic Acid (UDCA): This medication is the first-line treatment for ICP. It helps to improve liver function and reduce bile acid levels, thereby alleviating symptoms and potentially improving fetal outcomes. Dosages typically range from 10 to 15 mg/kg/day[5][6].
• Cholestyramine: This bile acid sequestrant can also be used to reduce itching, although it is less commonly prescribed than UDCA due to its side effects and the need for multiple doses throughout the day[7].

4. Fetal Monitoring

Due to the risks associated with ICP, continuous fetal monitoring is essential:

• Non-Stress Tests (NST): Regular NSTs can help assess fetal well-being, particularly if bile acid levels are significantly elevated.
• Ultrasound: Periodic ultrasounds may be performed to monitor fetal growth and amniotic fluid levels, as ICP can lead to complications such as intrauterine growth restriction (IUGR) and stillbirth[8].

5. Delivery Planning

In cases of severe ICP or when bile acid levels exceed certain thresholds (often above 40 µmol/L), early delivery may be recommended:

• Timing of Delivery: Induction of labor is typically considered around 37-38 weeks of gestation to minimize risks to the fetus while balancing the risks of continuing the pregnancy[9].
• Mode of Delivery: The mode of delivery (vaginal vs. cesarean) will depend on the overall health of the mother and fetus, as well as any other obstetric considerations.

Conclusion

Intrahepatic cholestasis of pregnancy is a serious condition that requires careful management to ensure the health of both the mother and the fetus. Standard treatment approaches focus on symptom relief, monitoring, and timely delivery when necessary. Ursodeoxycholic acid remains the cornerstone of pharmacological treatment, while close fetal monitoring is essential to mitigate risks associated with elevated bile acids. Women experiencing symptoms of ICP should consult their healthcare provider for personalized management strategies tailored to their specific situation[10].

References

1. [1] Maternal cardiovascular and haematological complications.
2. [2] Recommendations for Testing, Managing, and Treating.
3. [3] Stillbirth - Prevention, Investigation, Management and Care.
4. [4] A multi-centered trial investigating gestational treatment with...
5. [5] ICD-10 Coordination and Maintenance Committee Meeting.
6. [6] Medicare Program; Proposed Hospital Inpatient...
7. [7] Obstetric outcomes in pregnant women with seizure disorder.
8. [8] Bile Acid Signaling in Metabolic and Inflammatory...
9. [9] CHAPTER 6 OBSTETRICS.
10. [10] CHAPTER 6 OBSTETRICS.