Rare complications of pregnancy

The exact cause is not known, but it is widely accepted that in those affected, the high oestrogen level in the blood has in someway altered the functioning of the liver cells, causing various bile chemicals that would normally pass into the gut to build up in the blood instead.

It is generally not regarded as harmful to the mother - and there are no long-term problems - but it can be associated with an increased risk of stillbirth or premature death of the baby if the ICP is not recognised and treated.

ICP is a relatively rare condition, apparently with some hereditary links (grandmother, mother and sisters, but it sometimes skips generations), occurring in less than one in 1,000 pregnancies. However, it is up to four times as common in multiple rather than single pregnancies. If it does appear in a pregnancy, there is a 60-70 per cent chance that it will recur in a future pregnancy, often with increased intensity.

Ants in your pantsIntense, generalised itching (pruritis) is the main (and sometimes only) feature, which is caused by the increased level of bile salts in the blood. It usually begins in the third trimester, but may occur any time after 20 weeks. The itching, which can be very severe, is usually noticed first at night and can be most intense on the palms and the soles. Jaundice, caused by increased levels of bile chemicals in the blood, can also appear in ICP. Confirmation of the diagnosis is usually made from laboratory test results.

The treatment has two primary objectives:

• To try and alleviate the itching, which can be very intense. This is not easy to achieve as medication is not very effective.
• To induce labour when the baby is thought to be mature enough to be safely delivered, certainly in cases where any foetal distress is noted.