Cholestasis is a Greek word: Chole means bile, a substance secreted in the liver which helps in digestion of fat and stasis means standing still. Obstetric Cholestasis is a condition caused by acute or long term interruption in the excretion of bile from the liver as some bile (bile salts) leaks into the blood stream. It is also known as Intrahepatic cholestasis of pregnancy (ICP).
It usually occurs during third trimester of pregnancy and resolves spontaneously after delivery.
Obstetric cholestasis affects 0.7% of pregnancies and about 1.2–1.5% of women of Indian–Asian or Pakistani–Asian origin. The prevalence of Obstetric Cholestasis is influenced by genetic and environmental factors and varies between populations worldwide.
The reasons or causes of obstetric cholestasis are not clear. However, hormonal changes during pregnancy and genetic factors are supposed to play an important role.
The stasis of the bile in the bile canaliculi with rise in conjugated bilirubin is probably due to excess estrogen circulating during pregnancy. It is the second most common cause of Jaundice in pregnancy, the first one being viral hepatitis.
Its onset is insidious and tends to recur in subsequent pregnancies (45-70% chance).
Pruritus is the predominant symptom especially on trunk and limbs without a skin rash and is often worst at night. The itching is sometimes so intense that mother may hurt her skin causing bruises and scratches. Other symptoms include:
- Nausea or vomiting
- Anorexia and malaise
- Dark colored urine
- Pale or light colored stool
When to call the doctor?
Whenever you face body itching, consult your doctor. It will help in early diagnosis and treatment which is beneficial to both mother and baby.
Is there any risk to mother and baby?
Yes, there is little risk. Sometimes the itching is so immense that it leads to scratches on skin.
Maternal risk: It may cause Vitamin K deficiency in mother which can lead to postpartum hemorrhage.
Fetal risk: It may lead to preterm labor and stillbirth in severe cases (1 in 100 cases)
Diagnosis of Obstetric Cholestasis
When you report symptoms of itching, the doctor takes complete medical history, genetic history and does physical examination. The blood tests advised for diagnosis include liver function test (LFT), screening for viral hepatitis, clotting screen. Your doctor may also conduct an Ultrasound in some cases to rule out presence of any gall stones or liver abnormality. Pregnancy specific ranges are considered for LFTs.
If there is persistent itching or pruritus with normal liver function test, after 1-2 weeks all the liver function tests are advised again to check the course of the condition.
Treatment of the Obstetric Cholestasis
The treatment course depends upon the liver function test and period of gestation. For itching, emollients like calamine lotion or even coconut oil are given for symptomatic relief. This helps in soothing the skin. Other medications are ursodeoxycholic acid or cholestyramine supplements. If you have any positive viral serology, then the line of treatment changes accordingly.
Personal care is mandatory with healthy diet. You should regularly follow up with your Gynecologist as recommended. Non-Stress Test (NST) every 1 or 2 weeks to check the well being of the baby is advised along with regular intake of the medication.
If you notice increased itching, dark yellow colored urine with yellow discoloration of eyes, sudden generalized weakness and fatigue, decreased fetal movements, persistent upper abdominal pain with vomiting, and fever then immediately consult your Gynecologist.
As the baby reaches maturity between 37 to 38 weeks, termination of pregnancy by induction is planned.
Dr Nupur Gupta,
Consultant & Unit Head,
Gynecologist & Obstetrician
Paras Hospital, Gurgaon