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Itching in pregnancy - Obstetric Cholestasis

obstetric; Cholestasis; itching; OC; liver; itch;;

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Obstetric cholestasis (OC), sometimes called cholestasis of pregnancy, is a liver disorder that a small number of pregnant women can develop, usually in the last three months (last trimester) of pregnancy. 

OC is a condition where the flow of bile from the liver into the gut is reduced, causing a build up of bile salts in the blood.  Bile is a yellow fluid produced by the liver, which contains waste products and chemicals (bile salts) to help digestion. 

The main symptom is itching (pruritis) without a skin rash.  The itching will completely disappear within a week or two of the baby’s birth and does not cause ongoing health problems for mothers. 

However OC can lead to an increased risk of death of the baby before birth, premature labour, bleeding within the brain of the baby and passage of a bowel movement (meconium) before birth into the fluid around the baby (amniotic fluid). This can get into the lungs of the baby and cause breathing problems after birth.

Symptoms

In a normal pregnancy, itching is not uncommon.  It is thought to be related to hormonal change and stretching of the skin. So women may not be aware that they have OC because they are told that itching in pregnancy is normal. 

  • In OC, the itching generally appears in the last three months of the pregnancy but it can start earlier. 
  • It usually begins on the hands and soles of feet, spreading to the fingers and toes and to the trunk.
  • There is no rash. 
  • It’s usually worse at night leading to sleeplessness and fatigue. 
  • A few women loose their appetite and feel generally unwell, and some may develop jaundice (rare). 
  • A few women have dark urine and pale bowel movements.

Diagnosis

Obstetric cholestasis can be confirmed by blood tests called Liver Function Tests (LFT’s) and a fasting serum bile acid test.  If these tests are negative but the woman continues itching, they should be repeated. 

Other causes of abnormal liver function, such as viral hepatitis, Epstein Barr virus (glandular fever) and cytomegalovirus, need to be ruled out before the diagnosis of obstetric cholestasis is made.  An ultrasound may be recommended to check for gallstones, which could be the reason why the flow of bile into the gut is blocked.

Management

You may be offered medication that helps the bile flow and reduces the level of bile acids in the blood.  You may have additional tests during the pregnancy to monitor your baby’s heart beat (CTG) and assess well being of the baby, ultrasound scans and on-going blood tests. 

Amniocentesis may be done.

Any decrease/absence of movements of the baby should be reported to a midwife or doctor immediately. 

Follow a healthy diet and stick to normal pregnancy guidelines which recommend avoiding alcohol and drinking plenty of water.  Calamine lotion may help with the itching.  Wear loose clothing, have cool baths and try not to get too hot. 

  • The baby may need to be delivered early (around 38 weeks) if bile acids and LFT’s remain high or are increasing.

Please speak with your midwife or doctor if you have any questions about Obstetric Cholestasis.

More information and references 

There is more about itching on the  Pregnancy, birth and baby website 
http://www.pregnancybirthbaby.org.au/

Maternity Care in South Australia.  Perinatal Practice Guidelines.   

Babycenter

Source

Women’s Assessment Unit, Lyell McEwin Hospital (South Australia), pamphlet 'Obstetric Cholestasis'

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The information on this site should not be used as an alternative to professional care. If you have a particular problem, see your doctor or midwife.

 

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