QuestionDear Dr. Rappaport,
I am a 32 year old woman in my 35th week of my second pregnancy. I have a healthy 7 year old boy as well. While I was pregnant with him, around my 4th month, i began to have severe itchiness all over my body to the point where i would scratch so hard i would bleed. my OB at the time dismissed it as PUPPS, (although i did not have any rash) and told me to take benadryl, which i did for the remainder of the pregnancy. the medication seemed to give me some relief. my son was born 10 days early and went into fetal distress, mecomium was found in the amniotic fluid, his heart rate crashed and i had to have an emergency C-Section delivery. He was born with no health problems, and is a very healthy child.
My concern is,that about 2 or 3 weeks ago, i started to have the similar symptoms, severe itchiness, and no rash. Still believing that I had PUPPS last time, I told my NEW OBGYN about the symptoms i had, and what i had taken she suggested i take benadryl and call if situation did not improve. benadryl only helps me to fall asleep at night when the itching is worse.
I recently became aware of something called Intrahepatic Cholestasis of Pregnancy. I have been reading about the symptoms and feel that this could be a posibility of what i have. I called my doctor and she said that "it could be a number of things", and scheduled an appointment this week for me to be examined, i already have a routine checkup scheduled for later in this week. I am terified because she did not say what else it could be. i also have similar extreme itchiness pain in the vaginal area which i had the first time and was diagnosed as an "external yeast infection" and given a topical cream for. What other conditions could be causing this if it is not Intrahepatic Cholestasis? I've read all the horrors of ICP and i am torturing myself with all the facts.
AnswerThere are many causes of itching during pregnancy. Benadryl is safe to use to control the itching. Your use of Benadryl in the last pregnancy did not have any relationship to the problems that presented during labor causing you to have an emergency cesarean section. Intrahepatic cholestasis is a condition characterized by accumulation of bile acids in the liver with subsequent accumulation in the plasma, causing itching and jaundice. The disease is usually self limited and maternal serum bilirubin levels are only slightly elevated. There is a slight increase in preterm births and stillbirths and maternal postpartum hemorrhage. Treatment is symptomatic. Cholestyramine is the drug most frequently used. Another cause for itching during pregnancy is gallbladder disease, such as gall stones or acute cholecystitis. A sonogram can usually detect stones in the gallbladder or common duct. If this is causing the problem and Benadryl is not helping, surgery may be necessary. There are many dermatoses that arise during pregnancy causing itching with or without a rash. Topical therapy usually helps and , of course, Benadryl will relieve the itching. (it also helps as a sedative). I would not worry about ICP right now. Allow your doctor to do a workup and discuss it more thoroughly. I can appreciate your concern, however since itching is so common, it is not likely that you have such a rare disease. Good luck.
