Obstetric Cholestasis

Obstetric cholestasis is a rare complication often encountered later on in pregnancy, where a build up of bile acids in the bloodstream causes the sufferer a persistent itch. This itch will usually remain throughout the last trimester of pregnancy and will only cease once the baby is born.

What is obstetric cholestasis?

Obstetric cholestasis, although only encountered during pregnancy, is actually a condition of the liver. Cholestasis is a condition where there is a reduced flow of bile going down the bile ducts in the liver, resulting in a build up of bile acids, which then leak out into the bloodstream. These acids are then circulated in the bloodstream and cause the mother to itch, generally with no additional rash visible on the skin.

The condition is extremely rare, usually only occurring in less than one in one hundred pregnancies within the UK, although it can be slightly more common in other parts of the world. It can, however, be hereditary and often the mothers, daughters and sisters of those affected have a higher risk of developing the condition themselves. It also appears to be more common in women carrying multiple babies, such as twins or triplets. Obstetric cholestasis is a recurring condition, so if you suffer with it in one pregnancy the chances are high that you will suffer with it again through any following pregnancies.

How do I know if I have it?

The symptoms of obstetric cholestasis do not tend to show themselves fully until around the 24th week of pregnancy. This is in the third trimester when hormone levels for the mother are generally at their highest, but it has been known to develop earlier or later than this.

Symptoms can be slightly different for each person depending on the severity of the case, but generally the symptoms always involves itching skin. The itching can be all over the body but is often strongest on the hands and feet. The itching may start quite mildly and only be concentrated in certain areas, but many sufferers complain of the itching getting progressively worse as the pregnancy evolves.

The itching of the skin can then affect sleep, concentration and frame of mind. It can become very distressing and stressful for the patient. For many, the urge to scratch is so intense that the skin can often become broken and bleed.

Other symptoms can include unexplained tiredness, a poor appetite or even a feeling of nausea. Because the condition is linked to changes in the liver, many sufferers complain of mild jaundice developing during the third trimester of pregnancy.

To confirm that you have obstetric cholestasis your doctor or midwife will offer you a simple blood test. This test will also rule out any other possible liver problems.

What causes obstetric cholestasis?

Despite a large amount of on-going research into the condition, doctors are still unsure as to what causes the changes in the liver. It is generally thought to be due to the large hormonal changes going on in the body during pregnancy. Around the 24th week of gestation the mother's body produces a large amount of hormones and it is thought that this increase of oestrogen and progestogen have an effect on the organs, especially the liver. Some women are more sensitive to these hormonal changes and will develop the build up of bile that leads to the symptoms of itching.

Other thoughts on causes centre around genetic factors, as it is more likely that you will develop the condition if it runs in the family, although it has been known to skip some generations. Some doctors say that environmental factors can also be a cause, as although the condition is quite rare in the UK there are certain areas where pregnant women are more affected. Thankfully, after giving birth it seems the symptoms will completely clear and there does not appear to be any associated long term problems with the liver or bloodstream.

How will the condition affect my baby and me?

Thankfully, the main problem is the unpleasant itching for the mother and the growing foetus does not seem to be affected by the condition. However, it is thought that there is an increased risk of the baby passing meconium, an early form of poo, whilst still in the womb, which can irritate the baby's lungs if breathed in during delivery. There is also an increased risk of your baby being born early, although this is usually due to the doctor's decision not to wait for natural labour. For many cases of obstetric cholestasis, you may be asked to consider early delivery of your baby and if so, you should discuss this in full with your doctor or midwife.

For the mother, there is a small risk of bleeding from the womb following delivery, but this has not officially been connected to the condition and is still being looked into. It is likely that you will be asked to attend more regular check-ups than normal and you may be asked to provide regular blood tests so your condition can be measured as you go along.

Are there any treatments that might help?

Sadly, there is currently no cure for obstetric cholestasis and the condition will only come to an end once the baby has been born. However, there are some treatments or medication that might help. These should always be talked through with your doctor or health professional.

The simplest treatment is keeping the skin cool as this will ease some of the itching. Try turning your heating down, keeping skin uncovered and taking cool showers or baths. Some mild moisturising creams, applied when chilled may help the skin to cool and allow you to get some sleep.

There are some medications that can reduce the build up of bile in the liver, but tests have not proved conclusive as to whether they affect the baby. It is also likely that you will need extra vitamin K supplements to make sure your levels are stable during the problems with your liver.