Filed under: Pregnancy & Fertility
Cholestasis of pregnancy occurs in late pregnancy and triggers intense itching, particularly on the hands and feet.
By definition, cholestasis is any condition in which the flow of bile — a
digestive fluid — from the liver is blocked. Extrahepatic cholestasis
occurs outside the liver. Intrahepatic cholestasis occurs inside the
liver. Pregnancy is one of many possible causes of intrahepatic
cholestasis. Other names for cholestasis of pregnancy include obstetric
cholestasis and intrahepatic cholestasis of pregnancy.
Other than intense itching, cholestasis of pregnancy poses few problems
for mothers. Cholestasis of pregnancy can be dangerous for a developing
baby, however. Early delivery is usually recommended.
Signs and symptoms of cholestasis of pregnancy may include:
* Intense itching
* Dark-colored urine
* Light-colored bowel movements
* Yellow eyes or skin
Often, however, intense itching — particularly on the palms of the hands
and the soles of the feet — is the only symptom of cholestasis of
pregnancy. The itching may be worse, even intolerable, at night. The
itching is most common during the third trimester of pregnancy, but
sometimes begins earlier.
When to see a doctor
Contact your health care provider if you develop any signs or symptoms of cholestasis of pregnancy.
The cause of cholestasis of pregnancy is unknown. However, the condition seems to be triggered by pregnancy hormones.
Bile — a digestive fluid that helps the body break down fats — is
produced in the liver and stored in the gallbladder. Pregnancy hormones
can affect how well the gallbladder functions. Sometimes, pregnancy
hormones slow or even stop the flow of bile. Eventually, this excess
bile may enter the bloodstream. This is cholestasis of pregnancy.
Estimates of how many women develop cholestasis of pregnancy vary
greatly, from less than 1 percent to more than 15 percent of pregnant
women worldwide. For unknown reasons, cholestasis of pregnancy seems to
be more common during the colder months in Chile and Scandinavia.
Factors that increase the risk of developing cholestasis of pregnancy include:
* A personal or family history of cholestasis of pregnancy
* A history of liver damage
* Being pregnant with twins
* Having become pregnant by in vitro fertilization
In fact, the risk of cholestasis of pregnancy is highest for women who
had the condition during a previous pregnancy. After you've had the
condition once, the risk of developing it during a subsequent pregnancy
may be as high as 70 percent.
For mothers, cholestasis of pregnancy may temporarily hinder the
absorption of fat-soluble vitamins. Itching usually resolves within a
few days of delivery, and subsequent liver problems are uncommon —
although cholestasis is likely to recur with other pregnancies.
For babies, the complications of cholestasis of pregnancy can be much
more severe. For reasons not well understood, cholestasis of pregnancy
increases the risk of preterm birth and meconium — a substance that
lines the baby's intestines during pregnancy — in the amniotic fluid. If
a baby inhales meconium during delivery, he or she may have trouble
breathing. There's also a risk of fetal death late in pregnancy. Because
of the potentially severe complications, labor is typically induced
Preparing for your appointment
It's a good idea to be well prepared for your appointment with your
obstetrician. Here's some information to help you get ready for your
appointment, and what to expect from your doctor.
What you can do
* Write down any symptoms you're experiencing, even if you think they're normal pregnancy symptoms.
* Make a list of all medications, vitamins and supplements that you're taking.
* Take a family member or friend along, if possible. Sometimes it
can be difficult to soak up all the information provided to you during
an appointment. Someone who accompanies you may remember something that
you missed or forgot.
* Write down questions to ask your doctor. Preparing a list of
questions will help you make the most of your time with your doctor.
List your questions from most important to least important.
For cholestasis of pregnancy, some basic questions to ask your doctor include:
* What is likely causing my symptoms?
* Is my condition mild or severe?
* Is it safe to continue the pregnancy?
* What is the best course of action?
* What kinds of tests do I need?
* What are the alternatives to the primary approach that you're suggesting?
* Are there any restrictions that I need to follow?
* Will it be necessary to induce early labor?
* Do you have any brochures or other printed material that I can
take home with me? What Web sites do you recommend visiting?
In addition to the questions that you've prepared, don't hesitate to ask
questions during your appointment at any time that you don't understand
Tests and diagnosis
To diagnose cholestasis of pregnancy, your health care provider may:
* Ask questions about your medical history
* Perform a physical exam
* Send blood samples for laboratory testing to evaluate how well
your liver is working and measure the amount of bile in your blood
* Conduct an ultrasound exam — a test that uses high-frequency sound
waves to create images of internal organs — to check your liver for
Treatments and drugs
Treatment for cholestasis of pregnancy has two goals: relieve itching and prevent complications.
To soothe intense itching, your health care provider may recommend:
* Taking a prescription medication, such as ursodeoxycholic acid, to relieve itching and increase bile flow
* Using anti-itch creams or lotions that contain corticosteroids
* Soaking itchy areas in lukewarm water
To make sure your condition doesn't lead to complications with your pregnancy, your health care provider may recommend:
* Regular blood tests to monitor how well your liver is working and measure the amount of bile in your blood.
* Periodic ultrasounds and nonstress tests to monitor your baby's
well-being. During an ultrasound, high-frequency sound waves are
translated into a pattern of light and dark areas — creating an image of
your baby on a monitor. During a nonstress test, your health care
provider will check how often your baby moves in a certain period of
time and how much his or her heart rate increases with movement.
* Early induction of labor. Even if the prenatal tests appear
normal, your health care provider may suggest inducing labor early — at
or near 38 weeks, or even earlier if cholestasis is severe — which is
sometimes the best and only way to prevent complications.
Lifestyle and home remedies
To relieve intense itching, you might try:
* Applying an anti-itch cream, such as an over-the-counter hydrocortisone cream
* Taking a cool bath with cornstarch added to the water