Well, the day finally came and our little girl is here. Carmela Rose was born 11/29/12 @ 11:15 pm, weighing 7 lbs, 14 oz and 19 inches long. She came out kicking and screaming with a full head of hair and long beautiful eyelashes.
She was due on the 12th of December and we were scheduled for a C-Section on the 8th (today). I had had some physical complaints along the way but nothing serious until the end. My public bone was extremely painful to the point of not being able to even lay down on my side for the past month, I slept sitting on the couch.
Then something strange started to bother me. I began to have this all over itching, my chest itched, my back itched, my neck, my arms etc. and I did not have a rash at all. I mentioned this to my doctor and told him I was concerned. My clinical background as a Physician Assistant gives me just enough knowledge to be dangerous. I had learned that itching in late pregnancy without a rash is a symptom of Intrahepatic cholestasis of pregnancy. (ICP) is a pregnancy-related liver disorder in which there are abnormalities in the flow of bile (a substance produced by the liver that aids in the digestion and absorption of fats). These abnormalities lead to a build-up of bile acids (components of bile) in the mother's blood, resulting in symptoms such as severe skin itching. There is also risk to the baby which could be premature delivery (prior to 37 weeks), meconium ingestion, meconium aspiration syndrome and even stillbirth.
So even though the primary presentation is itching all over with out a rash the most prevalent itching occurs in the palms of the hands and soles of the feet. That I did not have, but to be sure the doctor did a blood test for my bile acid level. It came back normal 8 (ref range 0-10). So he felt that the itching was just due to pregnancy but not concerning for the baby. I was told to take benadryl at night to help get to sleep.
A week and a half goes by and I am still itching even worse, I also am tearing up my skin from scratching all the time. I call and ask if there is anything else I can do and they prescribe a steroid cream. I also ask if we can do the test again, they agree and draw blood. I go for my regular appointment and we talk about how he is still not concerned about ICP but do talk about moving up the c-section date due to the sever pain in my pubic bone. He tells me he will call to let me know if he can move it to the 5th of Dec.
The next day I am out of work for maternity leave one day. I am at home itching away and the phone rings, it's the doctor. He was originally calling to tell me he was going to be able to reschedule the c-section but had checked my lab work prior to calling me. The new test came back and my bile acid level was 80! He said he had to sit there for a minute and process it, he could not believe how high it was after being normal 2 weeks prior. He called and said that the high level warranted having the baby @ 38 weeks to avoid any complications, and could I come in that night.
So, we rallied the troops and went to the hospital. I had to wait 6 hours due to eating Oreo cookies and milk just prior to his call.
Then at 11:15 pm Carmela Rose was here and she was healthy!
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