How to Deal With Obstetric Cholestasis

Some experience severe itching late into pregnancy which can be a sign of cholestasis, a liver disease associated with pregnancy. This condition is caused by high levels of pregnancy hormones impacting the flow of bile through the gallbladder, often occurring in the third trimester when these hormones peak. This condition usually fades within the weeks following delivery. In some cases, cholestasis is divided into extrahepatic or intrahepatic cases based on whether or not symptoms are occurring in or outside the liver. Approximately 1 in 1000 pregnancies experience this condition, but obstetric cholestasis is more common in Chilean and Swedish groups.

What Causes Obstetric Cholestasis?

Obstetric cholestasis is caused when pregnancy hormones lessen the amount of bile moving down the bile ducts from the liver. Normally bile produced in the liver flows through ducts to the intestines to assist with digestion. Those suffering from obstetric cholestasis will see a reduced flow of bile which can lead to a buildup of salt in the intestines. This bile and bile salts can then leak into the bloodstream which will then circulate throughout the body, leading to widespread symptoms.

What Are the Symptoms of Obstetric Cholestasis?

Some experience obstetric cholestasis symptoms earlier in pregnancy, but most start to see symptoms after their 28th week. The most common symptom of obstetric cholestasis is itching on the palms or soles of the feet, though itching can become generalized. Insomnia or fatigue can also occur, particularly if the itching is worse at night. Some women scratch themselves excessively which can cause bleeding. Additional symptoms include mild jaundice, poor appetite or feeling sick. In most cases, symptoms disappear in a few weeks after giving birth.

It should be noted that mild itching during pregnancy is normal and may not be a sign of obstetric cholestasis. If you are concerned, your doctor can perform a blood test to check for this condition.

How to Treat Obstetric Cholestasis

1. General Methods

Keeping cool can help ease the itchiness caused by obstetric cholestasis. Lowering the thermostat, sleeping uncovered, taking a cool shower or bath and placing your hands and feet in ice water can provide temporary relief, particularly if you are having trouble falling asleep. Applying aqueous menthol or moisturizing creams can also be helpful.

2. Ursodeoxycholic Acid

Ursodeoxycholic acid is a natural bile acid which can be offered in medical form to help relieve itching. This can help to improve blood tests for the mother, but does not usually improve this condition in the baby. Future research will help to better indicate these results.

3. Vitamin K Supplements

Obstetric cholestasis can limit your body’s ability to create blood clots. Some women with this condition may use vitamin K supplements to reduce the risk of heavy bleeding after giving birth. Talk to your doctor to determine if this is safe as it is unknown how taking these supplements affects a baby in the womb. Your baby will be given vitamin K supplements after birth when it is known to be safer.

More Tips on Treating Obstetric Cholestasis

  • If itching is more severe, corticosteroids or anti-itch medication can be provided.
  • Some find that taking milk thistle or dandelion root can also improve liver health to reduce symptoms.
  • You will need to go for regular blood tests to check your liver function and bile serum levels. Bi-weekly non-stress tests can help to record contractions and monitor the fetal heart rate to determine your child’s health.
  • If necessary, you will be given the steroid dexamethansone which will help your baby’s lungs mature more rapidly.

Here is a video to further explain the definition, causes, diagnosis and treatments of obstetric cholestasis:

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