ICP: the Pregnancy Complication We Almost Missed

by ParentCo. November 13, 2017

Sleeping woman feet under blanket

At my 34-week appointment, my doctor was upbeat, reassuring me that, unlike my first pregnancy that resulted in my water breaking a few days shy of 37 weeks, this baby was on track to make it full term. I left convinced there would be no scramble to the hospital, even as I directed my husband to put the infant car seat in the car that evening – just in case.

The night that everything changed

It wasn’t sudden like my water breaking in the night, but an itchiness on the soles of my feet that left me in tears and taking Benadryl just to fall asleep. I wasn’t alarmed by the itchiness – more annoyed than anything else. Over the past few weeks, I thought I had been dealing with overly sensitive skin during pregnancy, changing my moisturizer twice, stopping the use of any bath salts or bubble bath, even adding athlete’s foot medication to our grocery list as I scratched mindlessly in the evening. This never phased me, despite the fact there was no obvious rash. The next morning everything was fine and I continued about my day, only to have the itching return that evening again – this time to my arms and wrists. This time, I tried a topical Benadryl solution to no avail, while my husband was convinced there was a flea infestation in the house I was overly susceptible to. I, on the other hand, did what every millennial does – I googled it.

Itchy feet during pregnancy: Know when it's dangerous

I hadn’t even fully typed out my query when itchy hands and feet pregnancy third trimester popped up as a suggestion. I clicked it. Itchy Feet During Pregnancy: Know When It's Dangerous was the top result. The article talked about how itchiness that starts mainly in the hands and feet could be a serious condition called Obstetric Cholestasis or ICP. Essentially this complication is caused when pregnancy hormones cause the liver to shut down and bile is released into the mother’s bloodstream which is potentially fatal for the baby past 36 weeks. The next morning, I called my doctor, gave them the symptoms I was having (without saying I Googled it) and they brought me in for an appointment and blood test immediately. I’m thankful they all but diagnosed it without waiting for the bloodwork to come back, and I walked out of that appointment with a prescription, the first of my bi-weekly non-stress tests scheduled and only one question “when did you Google this?” (I consider this a valid question since just thinking about being itchy causes me to itch.) Over the next five days, the itching calmed down, or only started when I thought about it (or maybe it was constant and I just didn’t notice it as much as those first two nights). I laughed slightly to myself thinking that I had fallen for the “Doctor Google” trap, and tried not to obsess about when the blood work would come back in. The test took five days to come back because these blood tests are done at only a few labs across the country, but as soon as I got a call from my doctor herself, instead of a nurse, I knew it was bad news. My bile acids were four times the amount they should be, in addition to irregular liver test functions, which put me in the severe category. Thanks to diligent research on the condition and a very active Facebook group, I wasn’t surprised when the doctor started talking about when they would induce me. The problem with ICP is that the bile acids in your blood can affect the placenta, causing preterm labor, breathing issues, fetal distress, or (in up to 15 percent of untreated cases) stillbirth. The longer you carry a baby with ICP, the higher risk of these complications, even on medicine and monitoring with ultrasounds and non-stress tests.

"If you don’t feel the baby move ..."

I told myself that my doctors knew exactly what they were doing. There was no hesitation with the diagnosis or the treatment. It was exactly what was supposed to be done, but the next two weeks were full of worry based on one piece of advice. “If you don’t feel the baby move more than four times in an hour, go to labor and delivery immediately.” Seriously? What if I stopped paying attention to the baby? What if I got busy? I found myself waking up in the middle of the night, not to itch, but just to make sure I felt her move. It was exhausting. ICP affects 6,000 pregnant women a year. Without an internet search, this story could have turned out differently. I’m thankful for women who have shared their stories. I’m thankful for my doctors who believed me right away when I didn’t fully believe it myself. I read stories about people who are bloody from scratching, who say the scratch is not a normal scratch but something more. Not always. Mine was normal except for those two nights that had me Googling. Itchiness of any form, especially on your hands and feet during the third trimester can be cause for serious alarm, and I hope my story will help inform more people about it. Note: My daughter was born completely healthy and happy when she was induced at 37 weeks.



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