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Obstetric Cholestasis
Obstetric cholestasis is an uncommon complication of pregnancy but has potentially far reaching consequences. A build-up of bile acids in the bloodstream causes a persistent and often severe itch in the last trimester of pregnancy. There may be a small increased risk of complications of pregnancy associated with this condition, but the evidence is not conclusive. The symptoms go when you have your baby. Some treatments may help to ease the itch.
Obstetric cholestasis is an uncommon complication of pregnancy but has potentially far reaching consequences. A build-up of bile acids in the bloodstream causes a persistent and often severe itch in the last trimester of pregnancy. There may be a small increased risk of complications of pregnancy associated with this condition, but the evidence is not conclusive. The symptoms go when you have your baby. Some treatments may help to ease the itch.
This liver disease is normally diagnosed after the mother-to-be notices an unusual itching, often on the palms and the soles of the feet. Fortunately, the mother's illness normally disappears outside of pregnancy.
What is obstetric cholestasis?
Obstetric cholestasis is a condition of the liver which occurs in some pregnant women. Cholestasis means there is a reduced flow of bile down the bile ducts in the liver. Some bile then leaks out into the bloodstream, in particular the bile salts. These circulate in the bloodstream and can cause the symptoms. This can cause serious problems for the unborn baby, including premature birth and fetal distress. Tragically, some babies are stillborn. Much uncertainty surrounds why this disease can put babies at risk, and how best to protect them. Researchers are searching for answers, by investigating possible effects on babies' hearts. It is because of this potential correlation that ALL woman are asked to contact Dr. Petrina or their respective doctor or midwife if they develop excessive itchiness, especially to the palm of the hands or soles of the feet. There appears to be no direct correlation to the severity of symptoms and outcomes, the only sure way to assess the severity is to perform blood tests and identifying the level of bile salts.
It is still a relatively uncommon condition but vigilance and prompt reporting of symptoms minimises the risks. You should always feel comfortable talking with your doctor and or midwife if concerned. Please contact Dr. Petrina if you have any questions or concerns pertaining to this.
Who gets obstetric cholestasis and how common is it?
Obstetric cholestasis occurs in less than 1 in 200. It is more common in multiple pregnancies such as twins or triplets. Mothers, daughters and sisters of affected women have a higher than average risk of also being affected when pregnant. If you have obstetric cholestasis in one pregnancy, you have a higher chance that it will occur in future pregnancies.
It is more common in certain parts of the world. For example, in some countries in South America, especially Chile and Bolivia, up to 1 in 20 or more pregnant women develop this condition.
What causes obstetric cholestasis?
The exact cause is not clear. Hormonal and genetic factors may be responsible:
There may be other environmental factors which contribute. However, whatever the underlying cause, the pregnancy triggers the problem. Within a week or so after giving birth the symptoms clear and there is no long term problem with the liver.
What are the symptoms of obstetric cholestasis?
As stated above the most common symptoms are excessive itching especially of belly, palms of the hands and soles of the feet. The condition does not associate itself with a rash but visible marks may be left because of the severity of itch and resultant scratching.
Please Note: mild itching from time to time is normal in pregnancy. However, if you develop a constant itch that gets worse, tell your doctor.
Other less common symptoms do include:
What is the treatment for obstetric cholestasis?
There is no cure for obstetric cholestasis. As mentioned, the condition is not usually serious but can be and as such demands monitoring and attention. If the levels of bile salts are significant and there is any concerns from severity of the condition birth may be recommended. Symptoms go once you have the baby. The following may be advised by your doctor or midwife, which may help relieve symptoms.
General measures
Some women have found that keeping cool helps to ease the itch. Tips to do this include: wearing light clothing, utilise air conditioners, fans. Water immersion, cold packs can be employed and some soothing gels and creams may be utilised. Please consult with your Doctor or midwife.
What is obstetric cholestasis?
Obstetric cholestasis is a condition of the liver which occurs in some pregnant women. Cholestasis means there is a reduced flow of bile down the bile ducts in the liver. Some bile then leaks out into the bloodstream, in particular the bile salts. These circulate in the bloodstream and can cause the symptoms. This can cause serious problems for the unborn baby, including premature birth and fetal distress. Tragically, some babies are stillborn. Much uncertainty surrounds why this disease can put babies at risk, and how best to protect them. Researchers are searching for answers, by investigating possible effects on babies' hearts. It is because of this potential correlation that ALL woman are asked to contact Dr. Petrina or their respective doctor or midwife if they develop excessive itchiness, especially to the palm of the hands or soles of the feet. There appears to be no direct correlation to the severity of symptoms and outcomes, the only sure way to assess the severity is to perform blood tests and identifying the level of bile salts.
It is still a relatively uncommon condition but vigilance and prompt reporting of symptoms minimises the risks. You should always feel comfortable talking with your doctor and or midwife if concerned. Please contact Dr. Petrina if you have any questions or concerns pertaining to this.
Who gets obstetric cholestasis and how common is it?
Obstetric cholestasis occurs in less than 1 in 200. It is more common in multiple pregnancies such as twins or triplets. Mothers, daughters and sisters of affected women have a higher than average risk of also being affected when pregnant. If you have obstetric cholestasis in one pregnancy, you have a higher chance that it will occur in future pregnancies.
It is more common in certain parts of the world. For example, in some countries in South America, especially Chile and Bolivia, up to 1 in 20 or more pregnant women develop this condition.
What causes obstetric cholestasis?
The exact cause is not clear. Hormonal and genetic factors may be responsible:
- Hormonal factors. Pregnancy causes an increase in oestrogen and progesterone hormones. These can affect the liver in a way which slows down the rate of bile passing out along the tiny bile ducts.Some pregnant women may be more sensitive to these hormonal effects.
- Genetic factors. Obstetric cholestasis seems to run in some families (although it may skip some generations). One theory is that women who develop obstetric cholestasis may inherit a slight problem with the way bile is made and passes down the bile ducts. This does not matter when not pregnant.However, the high level of hormones made during pregnancy may tip the balance to cause a much reduced flow of bile.
There may be other environmental factors which contribute. However, whatever the underlying cause, the pregnancy triggers the problem. Within a week or so after giving birth the symptoms clear and there is no long term problem with the liver.
What are the symptoms of obstetric cholestasis?
As stated above the most common symptoms are excessive itching especially of belly, palms of the hands and soles of the feet. The condition does not associate itself with a rash but visible marks may be left because of the severity of itch and resultant scratching.
Please Note: mild itching from time to time is normal in pregnancy. However, if you develop a constant itch that gets worse, tell your doctor.
Other less common symptoms do include:
- Tiredness.
- Poor appetite and feeling sick.
- Mild jaundice. You may go yellow and have dark urine and pale stools. This is uncommon and due to an increased level of bilirubin (part of bile) leaking from the bile ducts into the bloodstream.
What is the treatment for obstetric cholestasis?
There is no cure for obstetric cholestasis. As mentioned, the condition is not usually serious but can be and as such demands monitoring and attention. If the levels of bile salts are significant and there is any concerns from severity of the condition birth may be recommended. Symptoms go once you have the baby. The following may be advised by your doctor or midwife, which may help relieve symptoms.
General measures
Some women have found that keeping cool helps to ease the itch. Tips to do this include: wearing light clothing, utilise air conditioners, fans. Water immersion, cold packs can be employed and some soothing gels and creams may be utilised. Please consult with your Doctor or midwife.
