Baby #2 is Coming Early: Cholestasis of Pregnancy

As it turns out, this nesting craze wasn’t a fluke. Apparently my body knew I would need to be prepared to meet our little girl sooner than expected.

I found out today (at 31 weeks, 5 days along) that our little girl will be coming early. I have Intrahepatic Cholestasis of Pregnancy (ICP). It’s basically a liver disorder in pregnancy that affects the bile flow from the liver. Instead of the bile flowing as it should, the bile acids back up into the mother’s blood steam. The condition can cause preterm labor, fetal distress, maternal hemorrhage, and stillbirth– so it’s considered a big deal. You can read more about it here. It should resolve on it’s own after the baby is delivered.

I had read about this disorder when I was pregnant with Josh, and even got tested for it at the time because I was dealing with majorly itchy skin. The labs they tested at the time were liver enzymes (AST/ALT) and bile acids. My lab results came back with normal results though, and I chalked it up to be a normal pregnancy ailment.

However, with this pregnancy my symptoms have been a little different. As I have written before, my hot feet at night time have been plaguing me for at least a month now. Last week I called the OB nurse and ran it by her, and, assuming that it was normal, I asked for ideas for home remedies. She said she had never heard of feet so hot in pregnancy that it prevented sleep, and neither had the other two OB’s she ran it by. They suggested that maybe it was some sort of neuropathy (that just occurred at nighttime?) in my feet and to follow up with my OB at my 32 week appt (I was not convinced at all that I had neuropathy in my feet, but since I felt dumb for calling in the first place I just basically put the thought out of my head immediately).

Two days after that phone call, the palms of my hands became incredibly itchy and kept me up for three nights in a row. I knew this was a symptom of ICP (itchy palms and soles of the feet — usually at nighttime — are the classic symptoms) and I had actually never had this symptom with my pregnancy with Josh. I debated (once again) calling to ask for labs to make sure I didn’t have ICP. I felt like a total hypochondriac (“Um, hi, it’s me again… yeah– still have hot feet and NOW I have itchy palms!” No thanks.) But the more I researched, the more I realized what a serious condition this was and I read one too many stories about how it caused stillbirth. So I decided to call, and since my OB was on vacation I left a message with the OB nurse specifically asking for an AST/ALT, and bile acid labs. They called me back and said that it was no problem and that the labs were ordered. I went and got labs drawn that day (yesterday).

Today, my liver enzymes came back normal but my bile acids came back elevated. I assumed I would just follow up with my OB at my appt on Friday but instead the OB nurse called me this afternoon and this is what she told me:

1. I have ICP, and it won’t be going away on it’s own until I have the baby. In fact, it will continue to get worse.

2. I need to start on medication (Actigall) right away to help the bile acids to flow better and not back up into my bloodstream. This doesn’t necessarily reduce the risk to the baby but it will make me less itchy.

3. I will need to start NST’s twice a week starting this Friday until the baby comes.

4. I will be induced early, probably 36-37 weeks (she wasn’t sure, but said my OB would clarify at my appt).

I have to admit, I was rather shocked. I was mentally prepared to see normal lab results posted to my chart and to go until 41+ weeks (itching like crazy) to have this baby. But now she will be coming in 4-5 weeks! Overall I have had a very comfortable pregnancy (as opposed to last time) and so it feels really strange to think about being induced early. Last time I was in so much pain that I would have given my right arm to be induced early!

The day was spent in a flurry of phone calls. Things like baby showers and out of town trips may need rescheduling. Hubby will need to be off work sooner than we thought. All I can say is, I’m glad that everything  is practically done in her nursery (thanks to my nesting instincts!).

In the meantime, please pray for our little girl– that the ICP will not harm her in any way. Please also pray she will do well respiratory-wise when she comes (I’m not anticipating any problems, but you never know). I’ll update again after my OB and NST appt on Friday.

This was from a few days ago. 31 weeks 3 days.

This was from a few days ago. 31 weeks 3 days.

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9 Comments

Filed under Baby, Pregnancy

9 responses to “Baby #2 is Coming Early: Cholestasis of Pregnancy

  1. Hang in there! We know someone who had it a few months back. Both Mom and Baby did fine.

  2. Friend, hold onto hope! Your little girl is a miracle and needs you to help ground her in calm. You are amazingly brave and strong. Abby had similar prognosis (though different reasons all together at 28 weeks) and an induction at 37 weeks scheduled with two NSTs a week and a high level ultrasound once a week. It’s a lot to take in, but let yourself be taken care of by anyone who is able. Focus on Josh and your sweet little girl and ride this out on the prayers of others. Oh, I so wish I was there in person to support you! Perhaps talk to your OB about things that you can do earlier than normal to prep your body for birth? If nothing else, praying that your heart it prepped and baby girl is safe! Hugs!

    • I totally thought of you yesterday, Lauren! How amazed I was that you made it to 37 weeks. I am definitely hopeful about our situation, although feeling nervous about another induction. Not sure much I do will prep my body for labor at 37 weeks. I tried a lot of things at 39 weeks with Josh and my body still wasn’t even close! Maybe it’ll be different this time because my body knows what to do this time around? Hugs to you too, and thanks for the encouragement!

  3. Oh goodness – what a worry! But it sounds like you have great medical support. Good luck, good luck, good luck 🙂 xx

  4. Katherine

    Praying for you and baby! Thanks for sharing.
    Love,
    Katherine

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