Obsteric Cholestasis

 

What is this?

This is a problem related to liver function in pregnancy, where there is a reduction in the amount of bile which normally flows out of the liver and into the digestive system. The bile then builds up in the liver, causing some of the bile acids to leak out into the blood stream.
 
What are the symptoms?

The main symptom of obstetric cholestasis is severe itching. Mild itching is very common in pregnancy, particularly over the abdomen, due to the skin stretching as the pregnancy advances. However, in obstetric cholestasis it is more typical for the arms, legs, palms of the hands and soles of the feet to be affected. It may keep you awake at night, or you may find you have scratched yourself so hard in your sleep that you have made yourself bleed.

Unlike itching caused by allergic reactions, obstetric cholestasis usually does not cause a rash. Other symptoms may include feeling slightly unwell, loss of appetite, passing pale stools, or dark urine, but these are less common. If you have any itching in pregnancy, it is important to mention it to your midwife, or if it starts between appointments, phone your maternity unit for advice.

How is it diagnosed? 

For obstetric cholestasis to be diagnosed accurately, you will need to have some blood tests. These will look at your liver function, and also measure the level of bile acids in your blood. If you do have obstetric cholestasis, these blood tests will need to be repeated at regular intervals, usually weekly.
 
Is it dangerous?

There are not usually any serious risks to the mother if the condition is treated, nor is it thought to cause any long term liver damage. However, the lack of bile in the digestive tract may impair the bodys ability to absorb fat, and certain fat-soluble vitamins, including vitamin K, which is needed for blood-clotting. There may be emotional and psychological effects too, as the constant itching and associated lack of sleep can be exhausting and very stressful.
 
Are there any risks to the baby?


There is a higher incidence of going into labour early with obstetric cholestasis, and some suggestion that it can cause fetal distress. You will need regular fetal monitoring and ultrasound scans if you have this condition, and your labour may be induced early, usually at about 38 weeks.

How is it treated?

The usual treatment is with ursodeoxycholic acid tablets [URSO], to improve the flow of bile out of the liver into the gut, thus decreasing the amount of bile acid in the blood stream. Tablets and creams are usually prescribed to help alleviate the itching. Also, vitamin K tablets may be given to help ensure normal blood clotting mechanisms. The liver function usually returns to normal once the baby is born.