Description

Intrahepatic cholestasis of pregnancy, commonly known as cholestasis of pregnancy, is a liver disease that can occur in pregnancy. The condition triggers intense itching, but without a rash. It is usually in the hands and feet, but may also occur in other parts of the body.

Cholestasis of pregnancy can make you very uncomfortable. But what is of more concern are the possible complications, especially for your baby. Due to the risk of complications, your pregnancy care provider may recommend early delivery time of around 37 weeks.

Symptoms

Intense itching is the main symptom of cholestasis of pregnancy. But there is no rash. Normally, it feels itching in the palms of your hands or the soles of the feet, but you may feel itchy everywhere. The itching is often worse at night and may disturb you so much that you can't sleep.

The itching is more common during the third trimester of pregnancy, but sometimes it starts before. You may feel worse as your due date approaches. But once the baby is born, the itching usually disappears within a couple of days.

Other less common signs and symptoms of cholestasis of pregnancy can include:

  • Yellowing of the skin and whites of the eyes, called jaundice
  • Nausea
  • Loss of appetite
  • Oily, foul-smelling stools

When to see a doctor

Please contact with your pregnancy care provider immediately if you begin to feel steady or itching in the extreme.

Causes

The exact cause of the cholestasis of pregnancy is not clear. Cholestasis is reduced or stops the flow of bile. Bile is the digestive fluid made in the liver that helps break down fats. Instead of leaving the liver by the small intestine, the bile accumulates in the liver. As a result, bile acids, eventually enter the bloodstream. The high levels of bile acids appear to cause symptoms and complications of cholestasis of pregnancy.

The pregnancy hormones, genetics and the environment may play a role.

  • Hormones. Pregnancy hormones increase the closer you get to your due date. This can slow down the flow of bile.
  • Genes. Sometimes, the condition runs in families. Certain changes in the genes have been identified that may be linked to the cholestasis of pregnancy.
  • Environment. Although the exact environmental factors are not clear, the risk varies according to the geographical location and the season.

Risk factors

Some factors that may increase your risk of developing cholestasis of pregnancy include:

  • A Personal or family history of cholestasis of pregnancy
  • The history of liver damage or disease, including hepatitis C and stones in the gallbladder
  • Being pregnant with multiple babies
  • Pregnancy at an older age, as of 35 years or more

If you have a history of cholestasis in a previous pregnancy, the risk of developing during another pregnancy is high. Around 60% to 70% of women who happen again. This is called a recurrence. In severe cases, the risk of recurrence can be as high as 90%.

Complications

The complications of cholestasis of pregnancy appears to be due to the high levels of bile acids in the blood. Complications can occur in the mother, but the baby is in development, is especially at risk.

In mothers, the condition may temporarily affect the way the body absorbs fat. The poor absorption of fat can result in decreased levels of vitamin K-dependent factors related to the coagulation of the blood. But this complication is rare. The future of liver problems may occur, but are rare.

Also, cholestasis of pregnancy increases the risk of complications during pregnancy such as preeclampsia and gestational diabetes.

In infants, the complications of cholestasis of pregnancy can be serious. They may include:

  • Being born too early, also called preterm birth.
  • Problems of the lungs by inhalation of meconium. Meconium is the sticky, green substance that normally accumulates in the development of the baby's intestines. The meconium can pass into the amniotic fluid if a mother has the cholestasis.
  • The death of the baby at the end of the pregnancy before delivery, also called fetal death.

Because the complications can be very dangerous to your baby, your pregnancy care provider may consider inducing labor before your due date.

Prevention

There is no known way to prevent cholestasis of pregnancy.

Diagnosis

For the diagnosis of cholestasis of pregnancy, pregnancy care provider generally:

  • Questions about your symptoms and medical history
  • Do a physical exam
  • Blood tests to measure the level of bile acids in the blood and to check how well your liver is working

Treatment

The goal of the treatment of cholestasis of pregnancy to relieve the itching and prevent complications in the baby.

Relieve itching

To soothe the intense itching, your pregnancy care provider may recommend:

  • Taking a prescription drug called ursodiol (Actigall, Urso, Urso Forte). This medication helps to reduce the level of bile acids in the blood. Other medications to relieve the itching can also be an option.
  • The soaking of itching in the areas of cold or warm water.

It is best to talk with your pregnancy care provider before starting any medication for the treatment of itching.

Monitoring the health of your baby

Cholestasis of pregnancy can cause complications in your pregnancy. Pregnancy care provider may recommend close monitoring of your baby while you are pregnant.

Monitoring may include:

  • Without effort to the test. During a nonstress test, your pregnancy care provider will check your baby's heart beat, and how much the heart rate increases with activity.
  • Fetal biophysical profile (BPP). This series of tests helps to control your baby's well-being. Provides information about your baby's heart rate, movement, muscle tone, respiratory movements and the amount of amniotic fluid.

While the results of these tests can be reassuring, not able to predict the risk of preterm labor or other complications associated with cholestasis of pregnancy.

Principles of delivery

Even if prenatal testing are within the standard limits, the pregnancy care provider may suggest the induction of labor before your due date. Early-term delivery, about 37 weeks, you can reduce the risk of fetal death. Vaginal delivery is recommended for the induction of labor unless there are other reasons for a c-section is necessary.

The future of birth control

A history of cholestasis of pregnancy may increase the risk of return of symptoms, with contraceptives that contain estrogen, so that other methods of birth control is generally recommended. These include the progestin-containing contraceptives, intrauterine devices (Iud) or barrier methods, like condoms or diaphragms.

Lifestyle and home remedies

Home remedies may not offer a great relief for the itching due to cholestasis of pregnancy. But it doesn't hurt to try these tips to calm:

  • The cold baths, which can make the itching feel less intense
  • The oatmeal baths, creams or lotions, which can soothe the skin
  • The icing on the cake of a particular itchy patch of skin, which may briefly reduce the itching

Alternative medicine

The research of effective alternative therapies for the treatment of cholestasis of pregnancy is insufficient, so that the pregnancy care providers, in general, not recommended for this condition.

Several studies have examined the possibility that the supplement S-adenosyl-L-methionine (SAMe) could relieve the itching associated with cholestasis of pregnancy. But the data are contradictory. When compared with ursodiol in the first trials, the Same didn't work as well. It may be safe when used for a short time during the third quarter. But the risks to the mother and the baby are not well known. Often, this drug is not recommended.

The safety of other alternative therapies has not been confirmed. Always consult with your health care provider before trying an alternative therapy, especially if you are pregnant.

Preparing for your appointment

It is a good idea to be prepared for your appointment with the obstetrician or pregnancy care provider. Here's some information to help you prepare for your appointment, and what to expect.

What you can do

To prepare for your appointment:

  • Make a list of the symptoms that you have. Include all the symptoms, even if you don't think that is related.
  • Make a list of all the medicines, vitamins, herbs and other supplements that you take. Take note of the dosage and how often you take.
  • Have a family member or a close friend to go with you, if possible. You can give a lot of information in your visit.
  • Take a notebook with you. Use to take notes of the important information during your visit.
  • Make a list of questions. This can help you remember the important points you want to cover.

Some questions may include:

  • What is likely causing my symptoms?
  • Is my condition is mild or severe?
  • How is that my condition will not affect my baby?
  • What is the best course of action?
  • What kinds of tests do I need?
  • There are alternatives to the treatment that you are suggesting?
  • Are there any restrictions that I need to follow?
  • I have to have labor induced early?
  • Do you have any brochures or other printed material I can have? What sites do you recommend?

Do not hesitate to ask questions during your appointment, or if you do not understand something.

What to expect from your doctor

For a better understanding of your condition, your pregnancy care provider may ask questions such as:

  • What are the symptoms?
  • How long have you had symptoms?
  • How bad are the symptoms?
  • Can you feel your baby move?
  • Nothing seems to improve the symptoms?
  • What makes your symptoms worse?
  • Have you been diagnosed with cholestasis during any previous pregnancy?

Cholestasis of pregnancy can be a worrying diagnosis. Work with your pregnancy care provider to make sure that you and your baby receive the best possible care for this condition.

Symptoms and treatment of Cholestasis of pregnancy