IHCP during pregnancy – A serpent under flower

My office laptop showed me only about 324 unread mails that I needed to read and work upon. Three hundred and twenty-four freaking unread mails! Unlike in my Gmail, these were not promotion mails that I could just sweep to archive. This usually happened on days when I had back to back calls and meetings since 9 am. God help me, I thought. I just took a deep breath when my last call ended and looked at my colleague. I must have had a puppy face because she told me, “Get up and go home!”

My gynecologist had asked me to stretch every now and then and drink lots of water to keep myself hydrated. I followed her advice strictly and ended up going to the loo every half an hour. But it was my first pregnancy, and I didn’t dare to do anything out of the rule book. I checked my watch. It was at 3:30 pm. “Could we go down for juice?” I asked my colleague. She gladly obliged. It’s been a long day for her as well.

While she grabbed her coffee and I drooled over it. No caffeine. I sipped my juice, my hand began to itch. “You should go to your leaves now.” My colleague said. My doctor was ok with me working for as long as I could. She wanted me to be physically active so that delivery would be a cakewalk. Wait, did I just say cakewalk? No delivery is a cakewalk, ever. I did pregnancy yoga in the morning. I worked as much as I did before my pregnancy, ate healthily, no unwanted weight gains, no problems of morning sickness, no mood swings. I thought they would give me a medal afterward for being a role model of a pregnant woman. And then it happened.

I opened my shoes and reached down to scratch my feet. I had stopped wearing heels, and I thought that the shoes made the bottom of my feet itchy. But my hands itched too. My palms to be specific. I told this to my colleague because she saw that relief on my face after I have scratched my palms red. She told me it is normal. I shrugged because I knew that she is right. Pregnancy brings about numerous changes in the body, including the skin and itchiness, which is a normal outcome.

But the itchiness continued for the rest of the day, and I applied my hand cream generously, thinking it was dry skin. At night, I had bouts of these phases when I was tempted to scratch the surface off my feet with a vegetable peeler. The next day, I spoke to my mother-in-law and my mother (they needed assurance daily that I was ok) they both said that I need to apply coconut oil on areas where it is itching. My husband, who is almost half a doctor from his incessant research on the internet, checked it up on Google and said that it’s normal, but let’s see the doctor. “This could be something,” he said.

The test: When my doctor heard about the symptoms, she asked me to go for an LFT immediately. For the uninitiated, LFT is a liver function test. I got the test done the very next day, and online results were in by evening, which I sent as a Whatsapp text to my doctor. She replied, “Meet me. Now.”

The report showed an elevated ALT (Alanine aminotransferase) and AST (Aspartate aminotransferase) enzymes. And she diagnosed me with IHCP or Intrahepatic Cholestasis of Pregnancy. This was the first time I heard of it because none of the pregnancy books I read had mentioned it.

Occurrence: IHCP turned out to be a severe liver disorder that affects only about 1 or 2 women in every thousand pregnant women in the US. In South America and India-Pakistan, the occurrence is somewhat higher, affecting only about 1% to 2% pregnancies. How I landed myself in that rarity, I had no clue. The doctor’s advice was to have immediate delivery. Since my doctor and I both wanted normal delivery, she said that she would induce labor. The delivery was to happen after two days, but I was to contact my doctor at the slightest sign of discomfort (apart from the itching which became severe at night).

That was the first time in my entire duration of pregnancy when I began to feel helpless. I started reading about IHCP. I thanked God that I had just crossed 35 weeks of gestation, which means my baby would not be medically called “pre-term,” but I was at the 36th week, which meant that my baby wouldn’t be full-term as well.

Symptoms: It is a condition that usually happens in the later stages of pregnancy when the bile gets trapped in the liver and does not flow smoothly into the gall bladder. This causes a build-up of bile that starts leaking into the bloodstream. Hence the feeling of itchiness. But itchiness is common during pregnancy due to the distended skin around belly, hips, and breast. However, itchiness in the palm and bottom of feet is linked to IHCP. Also, lighter stools, darker urine, and yellowish skin and eyes are apparent symptoms of the disorder. I had the worst itching that kept me awake at night.

Causes: Genes càn carry this trait, although there is no way to verify this as my paternal grandmother isn’t alive, and on my mother’s side, no one had it. Although one can’t be sure because IHCP can easily go undetected. Pregnancy hormones such as estrogen and progesterone also disturb the functioning of the liver and hence may cause this in some cases such as mine.

Consequences: I began to feel depressed when I read about the possible consequences. My doctor had mentioned that it is important to take the baby out immediately because IHCP causes “distressed” fetuses to release meconium while still inside the mother’s body, which is called meconium staining. Meconium is the first baby poop that is sticky and dark. If the baby ingests meconium or it gets into his respiratory tract, it could be fatal. Stillbirth, fetal distress, and premature birth are some of the consequences of IHCP. Although it has no effect on the mother’s long term health as it goes away after pregnancy.

I held my tummy and prayed to God that things be alright. The last couple of days became a nightmare because of the sudden transition from a smooth, hassle-free, healthy pregnancy to one which is complicated. I was admitted to the hospital at 7 am on the day. My doctor had to induce labor thrice because my baby wasn’t ready to be delivered so soon. Finally, at 10:30 pm, after a whole day’s prayers and hard work, my little fairy emerged, blissful in sleep and feisty in her cries.

I am thankful to my husband for finding out that such a prominent symptom of itching could be so adverse and to my doctor for taking immediate corrective action. But I can’t imagine what can happen if this goes undetected in a pregnancy. There is so much to know, and no amount of reading prepares us thoroughly. I really hope that expecting mothers and fathers become aware of Intrahepatic Cholestasis of Pregnancy (IHCP), which is so rare, so hidden and so deadly because timely medical intervention can save a life.

Featured Image Credits: Wikimedia