Jan 4, 2013

Another Diagnosis: Cholestasis

I've had a few rare diagnoses during this pregnancy. I guess I shouldn't be surprised that these miracle twins who started with only a 5% chance of IVF success have also beat the odds on rare diagnoses.
I've blogged a bit about my itchiness (see the annoyances subheading here and prayer request here) and now I know what's causing it.
I have been diagnosed with obstetric cholestasis, sometimes called intrahepatic cholestasis since it occurs inside the liver. According to Cincinnati Children’s Hospital Medical Center, Cholestasis occurs in about 1 out of 1,000 pregnancies. Yet another rare condition.

"Cholestasis of pregnancy is a condition in which the normal flow of bile in the gallbladder is affected by the high amounts of pregnancy hormones." Basically, all of the pregnancy hormones have affected my gallbladder function and liver function. So, the bile my liver is producing to break down fats and aid in digestion is building up in my liver and spilling into my bloodstream. This is causing the severe itchiness that isn't made better by topical creams and lotions.

Most of the risks are actually to the babies not me and include an increased risk of stillbirth, premature labor, fetal distress, maternal hemorrhaging and meconium passage in utero. I will deal with discomfort, itchiness, fatigue, and nausea but all of the symptoms should go away within a few days of delivery.

Despite all of these scary risks, with treatment almost all of the negative outcomes can be avoided. The two most important factors in treatment are reducing the bile acids in the bloodstream with the medicine Ursodeoxycholic Acid (brand name Actigall or generic name Ursodiol)** and delivering the babies as early as lung maturity will allow. Since 37 weeks was our delivery plan for the twins anyway, we are good there.

I started the ursodiol today and will hopefully get some relief from it. I will be frequently monitored (already have appointments booked for twice weekly non stress tests, weekly ultrasounds, and weekly appointments). We will take things day by day. I'm still hopeful I will make it to 37 weeks but I have accepted that I might not.

Right now, I am overwhelmed. I am angry. I am terrified. I am disappointed that my body has done yet another thing to possibly endanger the babies. I am a hormonal, emotional mess!

** From www.icpcare.org: "Ursodeoxycholic Acid - UDCA (Actigall, Ursodiol, Urso) is one of the most important treatments for ICP. It’s a natural bile acid composition that displaces the more harmful bile acids in bloodstream. It has been shown to reduce levels of bile acids in umbilical cord blood and amniotic fluid. Some studies have shown it to significantly reduce pruritus, serum bile acids, transaminases, and bilirubin. Studies have shown that it improves bile acid transport across the placenta, which may reduce the risk of stillbirth (intrauterine death of baby) associated with ICP. It also helps to relieve some of the itching symptom associated with ICP."


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