Cholestasis Of Pregnancy: The Symptoms And Causes

Cholestasis of pregnancy or known in the medical field as Intrahepatic Cholestasis of pregnancy is a condition that is related to the liver and occurs during late pregnancy. During this condition, the mother is often affected by constant itching that develops on the hands and feet, but there are chances it could occur in other parts of the body too.

Cholestasis Of Pregnancy - Constant itching

In this condition, the woman could get extremely uncomfortable owing to the constant itching sensations, but it could become a problem and potential complications developer for the mother and baby. These complications could also force an early delivery.

Symptoms

During cholestasis of pregnancy, intense itching is the prime symptom. This itching produces no rashes of any kind, but women often feel itchiness on their palms and the soles of their feet. There have been cases where the women have handled the sensations everywhere on their body. As the itching progresses, it could get worse during the night and might cause lack of sleep, which is essential during pregnancy.

Cholestasis of Pregnancy - Itching Sensation

The most common time for these itching to occur is during the last three months of pregnancy, although this does not rule out the symptoms appearing earlier as well. These usually get worse as the due date approaches. The problems typically go away once the delivery is completed or at least a few days after it.

Here are some of the more common symptoms that may lead to cholestasis of pregnancy.

  • The whites of the eyes and skin start yellowing.
  • Women feel nausea
  • Severe loss of appetite

What causes Cholestasis of Pregnancy?

Cholestasis of pregnancy is often connected to the genetic role in the woman’s body. These conditions are also thought to run in families. But overall, the exact cause of cholestasis of pregnancy is mostly unclear.

Some studies talk about the involvement of pregnancy hormones, as it is understood that these hormones rise as the due date approaches. Doctors suggest that the rise of hormones affect the normal flow of bile – the digestive fluid that is made in the liver which helps break down fats. Usually, bile, after it is formed, leaves the liver, but in this condition, it is often found to build up within the organ, which results in bile salts entering the bloodstream, primarily causing itchiness.

What are the risk factors involved?
During Cholestasis of Pregnancy, A few risk factors involved with increasing the risk of cholestasis during pregnancy are:

  • Having a history of liver damage or liver diseases
  • If women are pregnant with twins or more children
  • Family or personal history of cholestasis of pregnancy.
  • Having suffered cholestasis of pregnancy while previously being pregnant

When the women have suffered from the problem in one of their previous pregnancy(s), then the chances of a recurrence are present in nearly 75 percent of women.

What complications could a pregnant woman experience?

Intrauterine Fetal Demise

The main concerns for pregnant women during cholestasis of pregnancy is the risk of the intrauterine demise of the baby or otherwise known as the stillborn baby. These complications have been previously noticed in some cases, but doctors usually recommend a Biophysical Profile of the baby, which using ultrasounds, evaluates the well being of the child, using a specific scoring system.

On the other hand, doctors also take a non-stress test to check on if there are other obstetrical indications that would show some distress or high risks to the baby. After these tests, if the doppler comes back as normal, then the baby is usually deemed healthy. This is usually a case in women who are older than 35-years, as there are chances of pregnancy complications in women that age or more.

Other complications that arise from cholestasis of pregnancy, there could be problems for the mother as well as the developing baby. There could be problems in mothers, like where their body’s ability to absorb fats could become a problem. This condition additionally leads to decrease in Vitamin-K levels which could further lead to blood clotting.

Bile Enters Bloodstream Causing Itching

For babies, however, there could be problems like:

  • Preterm birth
  • Lung problems, while breathing through in meconium
  • Stillbirth

For these complications connected to the baby’s health, doctors could, often suggest or consider inducing labor well before the due date.

Treatments

There are no known medical solutions which are designed to solve the problem of cholestasis of pregnancy. However, there are other remedies, more so away from the medical line of things, which claims to have solutions to this problem.

Cholestasis of pregnancy could be of varying levels in a pregnant woman. The levels and intensity of it determine the extensiveness of the problems it could cause to the mother and the baby. Although there are no known treatments for the problem, doctors usually try to manage the itching through various over the counter medications.

Case Study

In one of the cases, we encountered for Cholestasis of pregnancy, where the patient was a 37-year-old mother whom we evaluated for RPL or recurrent pregnancy loss. RPL is defined as recurrence of pregnancy loss for three or more times in a row. In accordance, we conducted a few tests, but those came out normal. In the process, she was administered with aspirin 75 mg, as well as injecting clexane, right from the 3rd month of pregnancy.

When the patient reached her 7th month of pregnancy, she developed itching all over her body, unusually intense reactions on her palms and soles.
The patient was administered I-Udiliv (150mg) three times a day, which was subsequently increased to 300 mg. In her 9th month of pregnancy the patient’s bile acid levels were 22 μmol/L w, and afterward, we explained to the patient a risk involving intra-uterine death, due to obstetric cholestasis of pregnancy. However, the patient’s NST/BPP doppler were regular when tested.

These risks were considered because the patient had a history with previous pregnancies, and thus an elderly elective planner was appointed, as well as we had to conduct a cesarean section for the child’s delivery. A cesarean section was performed considering the circumstances at hand, although the patient delivered a male baby, healthy and weighed 2.4 lbs.

This case reflects a positive outcome for a patent with a history of recurrent pregnancy loss as well as high levels of obstetric cholestasis while heavily pregnant. The results vary in different patients. Care and timely treatments are entirely a necessity when suffering from obstetric cholestasis during pregnancy.

About The Hospital:

Medisys Hospitals is a growing super speciality hospital in Hyderabad that represents the vision and mission of a group of highly qualified and experienced veteran medical professionals. Started in June 2016, it is a 200-bedded hospital with all medical and surgical specialties available. We rely on our in-house state-of-the-art diagnostic and therapeutic possibilities to provide high-level care for our patients.