Cholestasis of pregnancy is usually accompanied by intense itching and occurs in the last trimester of pregnancy. It is a condition in which the normal flow of bile to the gallbladder is impaired by high amounts of pregnancy hormones. This common liver disease poses no long-term threat to the mother. However it may be dangerous for the baby. Other names for cholestasis are obstetric cholestasis and intrahepatic cholestasis of pregnancy.

What are the causes of cholestasis ?

The exact cause of this complication is unknown. However it is known that pregnancy hormones affects gallbladder function. This may cause a slow down in the normal flow of bile from the liver. This causes a build up of  bile acids  in the liver and eventually these acids are spilled in the bloodstream. The deposition of bile acids on the mother’s tissues can lead to itching.

What are the symptoms of cholestasis ?

Symptoms of cholestasis include the following :

• itching usually on the hand and feet
• dark urine
• yellowing of skin and white part of the eye
• loss of appetite
• fatigue
• nausea

Am I at risk ?

The following women are at high risk of cholestasis

• women carrying multiples
• women with a personal or family history of cholestasis
• women with a personal history of liver disease

What is the effect of cholestasis on my unborn child ?

The baby relies on the mother’s liver to  remove bile acids from the blood. Therefore high levels of maternal bile can cause fetal stress.It may also lead  premature delivery or still birth.

Women with cholestasis are monitored closely during pregnancy. Once the baby’s lungs are matured, they may be induced.

How is it diagnosed ?

You doctor may ask for your complete medical history. He may also do a physical examination. A blood test will done to look at liver functions, bilirubin and bile acids.

How is cholestasis treated during pregnancy ?

Treatment of cholestasis during pregnancy aims at relieving itching. This can be done by soaking itching areas in warm water. You can also take prescription medication ursodiol (Actigall, Urso), This medication  reduces bile in the mother’s blood stream, relieves itching and prevents complications in babies.

You should however note that antihistamines are not effective in this condition and may pose a risk to developing baby.

Other treatment options for cholestasis include the following :

• cold baths or ice water. These slow down flow of blood through the body by decreasing the temperature
• bi weekly non stress test to monitor the fetus and record contraction
• regular blood test to monitor bile level and liver  function
• steroid Dexamethansone to increase the maturity of the lungs
• administration of vitamin K supplement to mother to prevent intracranial hemorrhage once the baby is born

 
Your health care provider may recommend early induction around 37 weeks even if all prenatal tests appear normal. This is done to prevent complications and fetal death.
 
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