A pregnant woman faces many challenges on a regular basis, some common, and others not. The entire body can be under threat to numerous diseases when you are pregnant. This is due to the immune system being overloaded and weakened as a result of the increased production of hormones. Cholestasis during pregnancy can be a difficult disease to manage.
Also known as obstetric cholestasis, it is an uncommon condition that occurs during pregnancy and affects the liver, causing itching in pregnancy. It results in the affected woman feeling itchy and affects one in 70 pregnant Indian women. This condition causes the blockage of the normal flow of bile in the body. Medical practitioners now prefer to call it intrahepatic cholestasis of pregnancy or ICP.
Because the flow of bile is blocked, the bile builds up in the liver. The bile then begins to leak into the bloodstream particularly the bile salts. When this happens, it makes the skin extremely itchy especially of the hands and feet. It usually manifests in the last trimester of the pregnancy. While this condition does not seem to have any long term effects on the mother’s health, it can cause severe complications for the infant.
There aren’t any clear reasons as to why cholestasis of pregnancy occurs. However, there are hypotheses that hormonal and genetic factors might play a role.
Some women might be highly sensitive to the changes in hormonal levels caused due to their pregnancy. The increase in oestrogen and progesterone affects the liver in a way that slows down the bile as it flows through the tiny ducts.
Women who have obstetric cholestasis in their family history have more chances of developing the condition themselves. This is because it seems to be inherited though it is known to skip generations. These women may have inherited a problem in the way the bile is produced and moved through the body. While this problem does not manifest otherwise, a change in the hormone levels during pregnancy could cause the condition to flare up.
Other reasons for the development of this condition include disease, infection and certain medicines.
The following cholestasis liver disease symptoms may be present if you are suffering from OC during your pregnancy:
If you experience intense itching around your feet and palms, do talk to your doctor immediately. Obstetric cholestasis can cause severe complications to the health of your baby and if you have this condition, then you and your baby will be monitored closely.
There are many factors that can increase the risk of the condition manifesting in pregnant women. These include:
Cholestasis of pregnancy affects both the mother and baby though it affects the health of the baby more so. Here are some of the ways in which cholestasis of pregnancy can cause complications.
The effect of cholestasis on the mother is usually non-life threatening. The condition can temporarily affect how the body absorbs fat-soluble vitamins though this will hardly affect her nutrition. The itching usually resolves itself within a few days after delivery and the condition does not cause any long term effects on the liver.
Obstetric cholestasis causes the baby to be born prematurely though the exact reason why is unknown. The foetus has a liquid known as meconium that could leak into the amniotic fluid. If the foetus then inhales the meconium during delivery, she will have complications with her breathing. The condition could also cause foetal demise in late pregnancy. Due to the high chances of stillbirth due to obstetric cholestasis, your doctor might want to induce labour by the 37th week.
Your doctor will suggest a blood test for detecting obstetric cholestasis called liver function test or LFT. Apart from this, she could also ask for a fasting serum bile acid test. If tests are negative but the itching continues, they must be repeated.
Your doctor might also suggest an ultrasound to detect obstetric cholestasis. This could rule out gallbladder stones. Other tests to rule out abnormal liver functions like viral hepatitis, Epstein Barr virus, and cytomegalovirus are conducted before a diagnosis of OC can be made.
While all these tests may seem intimidating, you must remember that they are not complicated and are extremely useful for helping maintain the health of your baby.
Your doctor will recommend treatments that will reduce the itching and spread of the condition and avoid the risk of stillbirth. The treatments include the following methods:
Many women find that relaxing provides relief. You can use the following methods, particularly at night, so that you can fall asleep easier.
Some women have also found that using a mild moisturising lotion has provided them with some relief. Using a lotion with menthol in it has helped others. Before you do use any lotion, have it green lighted by your doctor. Other remedies include:
Due to the complications posed by obstetric cholestasis, your doctor might recommend close monitoring of your baby. These measures may include:
Through this test, you medical practitioner will monitor how much your baby moves at certain times and how much her heart rate increases with the movement. The scores of the biophysical profile will give your doctor information about the volume of amniotic fluid as well as foetal muscle tone and activity.
Even if all the prenatal tests offer normal results, your doctor will recommend that she induce early labour by the 37th week. Since it is near impossible to predict when foetal death can occur, it is best to opt for early delivery.
The chances of a pregnancy with obstetric cholestasis occurring after a previous pregnancy with the condition are very high. If the condition occurs in your family, you too could have a pregnancy with this condition.
Since chances of stillbirth in this condition are very high, your doctor will recommend inducing labour between the 35th and 38th week. This is usually done around the 37th week.
Your doctor will take the following measures to ensure that yours and your little one’s health stays uncompromised after childbirth.
Obstetric cholestasis can be an uncomfortable condition for you, and can cause serious complications for your baby. Keep a note of all your symptoms and keep your medical practitioner in the loop. Maintain all appointments with her to ensure the safe delivery of your baby. Talk to your doctor about solutions for the itching and make sure you keep yourself stress free to relieve your discomfort.