How is ICP treated?
There is no consensus on the best way to treat ICP. Many hospitals have adopted a policy of ‘active management’ with ICP pregnancies in anticipation that this approach might reduce any risk to the unborn baby. The term ‘active management’ is used to describe various strategies that hospitals use to monitor your ICP pregnancy, and may include some or all of the following:
- Blood tests (bile acids and liver function). Recent research by Ovadia et al has shown that bile acids are more directly linked to the risk of stillbirth and are therefore vital in the management of ICP.
- Fetal movement monitoring (cardiotocographs (CTGs) and growth scans). There is no evidence to show that CTGs are of any benefit in the management of ICP. While they may bring reassurance to the woman, they should not be relied on as confirmation that all is well with the unborn baby. It is important therefore that women continue to monitor their baby’s pattern of movements at all times.
- Treatment with ursodeoxycholic acid (UDCA). The most recent trial of UDCA (called PITCHES; Chappell et al 2019) has shown that this drug is of no benefit to women who have ICP. However, some researchers still feel that it may be useful for the small group of women who have very severe ICP, but further research is needed on this.
- Treatment with other drugs.
- Many hospitals are still advising induction at around 37 weeks. Research by Ovadia et al has shown that some women will be able to wait until 39 weeks for induction, while other women with severe ICP may need to meet their babies as early as 34–35 weeks of pregnancy – see our recommended protocol for managing ICP.
It should be noted that none of these interventions is proven to protect your baby against the risk of complications associated with ICP.
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