Cholestasis Of Pregnancy

Cholestasis of pregnancy, also called obstetric cholestasis or intrahepatic cholestasis of pregnancy, is a liver disorder characterized typically by unbearable itching that occurs in late pregnancy. It affects hands and feet but the itching may spread to other body parts.

The term "cholestasis" refers to any disorder that causes obstruction in the flow of bile from the liver.

Cholestasis of pregnancy causes an intense uncomfortable itching, which is a non-serious symptom and does not cause long-term problems to an expectant mother. However, it may bring serious consequences to a developing baby. In such case, your doctor may induce early delivery.

Note that pregnancy itself can cause cholestasis.

Unbearable itching that occurs in late pregnancy is the main symptom of Cholestasis of pregnancy.

The condition is typically characterized by a “beyond normal” itching sensation. Hands and feet are the most commonly affected areas while some women may experience itching everywhere. You may feel heightened itching sensations during the night which might interfere with sleep. Itching starts most commonly during the third trimester of pregnancy, progresses as your due date approaches and subsides within a few days of delivery.

In addition, you may experience other signs and symptoms such as:

• Yellowing of the skin and eyes (jaundice)
• Nausea
• Reduced hunger

When to see a doctor

Contact your pregnancy care provider promptly if you begin to feel persistent or extreme itchiness.

The cause of cholestasis of pregnancy has not yet been established.

Some possible causes could be:

• Genetic factor
• Pregnancy hormones: Increased hormone levels during third trimester of pregnancy may delay flow of bile out of the liver, and lead to accumulation of bile in the liver. Itching is caused by deposition of bile acids in the mother's tissues.

The diagnosis of Cholestasis of pregnancy starts with question-answer session followed by a physical exam. 

Talk to your doctor if you are pregnant and experience unbearable itching.

How to prepare yourself for the visit

• Getting prepared for the visit can optimize the therapy and help make the visit more fruitful.
• List out all the symptoms.
• Write down your key medical information.
• Write down the names of all your medications, vitamins or supplements.

Make a list of the questions to ask your doctor.

Some typical question can be:

• What could be possible causes of my symptoms?
• Are my symptoms severe or mild?
• Can this condition affect my baby? Is it safe to continue the pregnancy?
• What are the tests that I need?
• Do I need to follow any restrictions?
• Do you suggest inducing early labor?

What your doctor wants to know

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor.

Your doctor might ask you typical questions like:

• What are your symptoms and when did you start noticing them?
• How severe are your symptoms?
• Has your baby been active?
• Does anything improve or worsen your symptoms?
• Do you have a history of cholestasis of pregnancy?

Your doctor may recommend blood tests to determine how well your liver is functioning, and measure bile concentration in your blood.

The goal of treatment of Cholestasis of pregnancy is to relieve itching and prevent complications.

Following measures can be taken to relieve and soothe intense itching:

• Prescription medication: Ursodiol is a prescription medicine that reduces blood levels of bile in mother. It also reduces itching and complications in the baby.
• Soaking itchy areas in lukewarm water

Intense itching may provoke you to take an allergic medication or apply steroid containing anti-itch cream to ease the symptoms. Remember that antihistamines do not always produce desired results and may even risk your baby. The use of anti-allergic medications is discouraged because temporary relief obtained by using these agents can make you miss the appointment, thereby delaying effective diagnosis and treatment. Preparations containing steroids are ineffective in treating itchiness caused by cholestasis of pregnancy and excessive use of steroid preparations can be harmful to the baby.

Preventing complications

Carefully monitoring of your baby during pregnancy can prevent or decrease the risk of complications to your baby.

You may take following measures:

• Non-stress tests and biophysical profile scores: These tests are used to evaluate fetal well-being. A non-stress test involves monitoring your baby’s movement and heart rate. The biophysical profile evaluates volume of amniotic fluid, fetal tone and activity. Note that these tests are not able to predict the risk of premature birth or other complications associated with cholestasis of pregnancy.
• Early induction of labor: Labor may be induced early if there is a risk of fetal death.

Due to poor availability of convincing data, alternative remedies for Cholestasis of pregnancy are not recommended. Current studies are focused on finding an alternative therapy for the condition.

Of them, S-adenosyl-L-methionine (SAMe), has shown some promise. Injecting SAMe may relieve itching but the effect on baby is still unknown.

Various other substances are being studied for their potential effects but none of them has been proven to be safe and effective.

Don’t try any of these alternatives without consulting your doctor.

Till now, no home remedies have been found to be effective against the itching caused by cholestasis of pregnancy.

However, you may try:

• Warm baths
• Applying ice on the affected area

There are several risks and complications associated with Cholestasis of pregnancy.

Risks

• Your risk is increased if you have a personal or family history of the condition
• History of liver disease
• Twin pregnancy

Complications

Cholestasis of pregnancy is not a serious concern for the mother’s health. Sometimes, it may reduce absorption of fat soluble vitamins but it has no effect on overall nutrition level. The condition usually shows spontaneous resolution and complete recovery occurs within a few days of delivery. But recurrence of the condition is a common problem. For babies, the complications can be more severe.

Some complications to the bay can be:

• Preterm birth: It is seen that cholestasis of pregnancy increases the risk of premature birth.
• Meconium exposure to the baby: Your child may release meconium into the amniotic fluid that surrounds the baby. When inhaled by the baby, it can cause breathing problems.
• Fetal death late in pregnancy.

To avoid such serious complications, your doctor may recommend inducing labor around the 37th week of pregnancy.