Itching Like Nobody’s Business

I had to go into the hospital this past Wednesday to see about this horrible all-over itching I’ve had for the past 3 weeks. It looks like it might be ICP (intrahepatic cholestasis of pregnancy), although the tests haven’t come back yet so I don’t know for sure.

The symptoms sure match. All-over itching? Check. Much worse at night? Check. Scandinavian background? Check.

It’s actually so bad that I cannot get to sleep at night until I’ve fatigued myself to the point where I’ll pass out within 3 minutes of hitting the pillow. I have some serious sleep-deprivation stamina, so this winds up being a 4 or 5am bedtime. And I’m still trying to hold down a full time job here.

It took me a while to find a good non-dumbed-down description of what the hell this thing is, so I’m reposting it here (from FemalePatient.com).

INTRAHEPATIC CHOLESTASIS OF PREGNANCY

Intrahepatic cholestasis of pregnancy (ICP) is caused by maternal intrahepatic bile secretory dysfunction. A genetic predisposition for this disorder has been described. It is a relatively rare condition that occurs in 1 in 10,000 pregnancies in the United States, but it affects 4% to 8% of pregnancies in Chile and Scandinavia. An association with hepatitis C viral infection has recently been identified as well. This disease is characterized by intense generalized pruritus that usually begins in the third trimester. Although constant, the pruritus is classically much worse at night. It may be most severe on the palms and soles. The important feature of intrahepatic cholestasis is the absence of primary lesions, such that excoriations are the only cutaneous finding. Jaundice is present in a minority of patients.

Abnormal hepatic excretion of bile acids during pregnancy is attributed to increased endogenous estrogen production. In theory, high estrogen levels alter the hepatocyte membranes, hindering bile salt transport. Intrahepatic cholestasis of pregnancy most likely represents the severe end of a spectrum that includes the common pruritus gravidarum (ie, pruritus in the absence of abnormal liver function tests). The severity of pruritus in ICP generally correlates with elevated serum levels of bile salts, which may be 10 to 100 times higher than normal values. While transaminase levels are usually only slightly elevated, alkaline phosphatase tends to be much higher than normal, partially due to the contribution of alkaline phosphatase from the placenta. Hepatitis C viral serologies should also be assessed, given the association with ICP. Neither routine biopsy nor immunofluorescence studies are useful for diagnosis.

Bland antipruritics and UVB light treatments are the mainstay of therapy. Ion-exchange resins that inhibit serum resorption of bile acids such as cholestyramine from the intestine can be helpful. Parenteral vitamin K supplementation may be warranted in patients with prolonged cholestasis to prevent maternal or fetal hemorrhage resulting from malabsorption of this vitamin.

Symptoms tend to dissipate within days of delivery, but there is a tendency toward later development of gallbladder disease in these women. There is a potential for recurrence in subsequent pregnancies or with OC use. Fetal risk is also a matter of concern. An increased risk of fetal distress and preterm delivery has been reported. The mechanism is unknown, but may be due to changes in fetal steroid metabolism from the maternal cholestasis. Fetal death in untreated patients has been documented at up to 10% in some studies. For this reason, strict surveillance is warranted. Some experts advocate delivery on demonstration of fetal lung maturity, as the majority of fetal deaths occur after 36 weeks’ gestation.

(Oh yeah, to catch everybody up: I’m pregnant. 24 weeks at this point. Due in late September.)

So, great, looks like I just wait this thing out… another 4 months… of no sleep…

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