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Cholestasis of Pregnancy

Definition


Disease: Cholestasis of Pregnancy Cholestasis of Pregnancy
Category: Digestive diseases
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Disease Definition:

Causing intense itching on the feet and hands in particular, cholestasis of pregnancy occurs in late pregnancy.
Any condition in which the flow of bile, which is a digestive fluid, from the liver is blocked is called cholestasis; when it occurs outside the liver then it is called extrahepatic cholestasis; and when it occurs inside the liver, then it is called intrahepatic cholestasis. One of many possible causes of intrahepatic cholestasis is pregnancy. Obstetric cholestasis and intrahepatic cholestasis of pregnancy are other names for cholestasis of pregnancy.
Early delivery is often recommended because although cholestasis of pregnancy poses few problems for the mother other than intense itching, it could be dangerous for a developing baby.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Dark-colored urine, yellow eyes or skin, light-colored bowel movements and intense itching are the signs and symptoms of cholestasis of pregnancy.
On the soles of the feet and the palms of the hands in particular, intense itching is usually the only symptom of cholestasis of pregnancy. The itching is most common during the third trimester of pregnancy, though it sometimes begins earlier. The itching may be worse at night, it could even become intolerable.
When developing any signs or symptoms of cholestasis of pregnancy, one should contact her health care provider.

Causes:

Pregnancy hormones seem to trigger cholestasis, though the exact cause of the condition is not clear.
The functioning of the gallbladder may be affected by pregnancy hormones when these hormones slow or even stop the flow of bile. Cholestasis of pregnancy is when pregnancy hormones affect the flow of bile and the excess bile enters the bloodstream.
The number of women who develop   cholestasis of pregnancy ranges between less than 1% and more that 15% of pregnant women worldwide. In Chile and Scandinavia, cholestasis of pregnancy seems to be more common during the colder months, though the reason behind that is not known.

The risk of developing cholestasis of pregnancy may increase due to the following factors:
 

  • Being pregnant with twins
  • A personal or family history of cholestasis of pregnancy
  • Having become pregnant by in vitro fertilization
  • A history of liver damage


Women who had cholestasis of pregnancy once have a 70% chance of developing it again.

Complications

Complications:

Cholestasis of pregnancy may temporarily obstruct the absorption of fat-soluble vitamins in the mother. Within a few days of delivery, itching usually resolves and subsequent liver problems are not common.
The complications of cholestasis of pregnancy may be far more severe for babies. The risk of preterm birth and meconuim, which is a substance that lines the baby's intestines during pregnancy, in the amniotic fluid, may increase due to cholestasis of pregnancy, and the reason of that is not really clear. The baby may have trouble breathing if he/she inhales meconium during delivery. There is a risk of fetal death late in pregnancy as well. Labor is usually induced early because of the potentially severe complications.

Treatments:

Relieving itching and preventing complications are the two goals of treatment for cholestasis of pregnancy.

Relieving itching:
The following may be recommended in order to soothe intense itching:
 

  • Soaking itchy areas in lukewarm water
  • Taking a prescription medication, such as ursodeoxycholic acid, to increase bile flow and relieve itching
  • Using anti-itch creams or lotions that contain corticosteroids


Preventing complications:
The following may be recommended to ensure that one's condition doesn't cause complications with her pregnancy:

Early induction of labor: The best and only way to prevent complications is inducing labor early, at or near 38 weeks, or even earlier if cholestasis is severe, which may be suggested even if the prenatal tests appear normal.

Regular blood tests: This is done to measure the amount of bile in the woman’s blood and monitor how well her liver is working.

Periodic ultrasounds and nonstress tests: The aim of this is monitoring the baby's well being. Creating an image of the baby on the monitor, high-frequency sound waves are translated into a pattern of light and dark areas during an ultrasound. During a nonstress test, the health care provider checks the frequency of the baby's movement in a certain period of time and how much his/her heart rate increases with movement.

Prognosis:

Not Available

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