Pregnancy Complications - Cholestasis (itching)
Obstetric cholestasis, also known as OC, cholestasis of pregnancy, ICP and intrahepatic cholestasis of pregnancy, is a pregnancy complication causing a build up of bile acids in the bloodstream resulting in severe all over itching and sometimes fatigue and insomnia.
The main symptom of cholestasis is persistant itching during the third trimester. The itching normally begins on the palms of the hands and soles of the feet and is often worse at night-time. In some instances the condition can result in jaundice whereby the skin takes on a yellow appearance. Although some treatments may help to relieve the itching, after the birth of the baby the itch will stop as the liver's function returns to normal.
Obstetric Cholestasis is more likely if there are other family members who have suffered from it and it is also more common in some parts of the world leading to suggestions that there may well be a genetic link.
Diagnosing Obstetric Cholestasis
It is important to inform your gp if you experience itching during pregnancy. Your gp will look for causes of itching such as your skin stretching which can cause itching. The itching associated with OC usually begins in the last trimester and can be severe. If your gp suspects you may be at risk he will order blood tests which will include a liver function test and a bile acid test. He may also send you for an ultrasound scan to check for gallstones.
Risks to the Unborn Baby
Unfortunately OC can pose some risks for your unborn baby; the risk of stillbirth is around 15% greater. As yet the reason for this is unknown. However, bile acids which cross the placenta may be responsible or placental problems may deprive the baby of oxygen.
OC can sometimes be managed with one of two drugs.
Ursodeoxycholic acid tends to be the first choice of treatment as it can sometimes eliminate or reduce the itching and also results in the liver function and bile acid results returning to normal.
Steroids, especiallly dexamethasone, is another drug which is sometimes used.
Because of a small but increased risk of maternal bleeding after birth, mothers suffering from OC are sometimes given daily doses of Vitamin K until the birth. Vitamin K helps with blood clotting. This also protects the baby from bleeding too.
Your baby will probably be delivered as soon as his lungs are developed enough to allow him to survive outside the womb and as a result he will be scanned regularly to monitor his progress. Most babies of mothers with OC are delivered between 35-38 weeks because the risk of stillbirth increases beyond this timeframe.
If you have been affected by OC during pregnancy it is likely, although not always the case, that you may get it again during future pregnancies.
Treatments for Itching
As yet, diet has not been proven to be a factor in OC, but it is advisable to reduce your intake of dairy foods, foods high in fat and fried food. This will mean less work for your liver. Try to eat a healthy balanced diet, limit or avoid alcohol altogether and increase your intake of water.
If the itching is very difficult you can try applying soothing ointments or creams such as calamine lotion. Avoid tight, synthetic materials and instead wear loose cotton clothes and try to keep cool.
Some women find alternative therapies such as homeopathy helpful in treating the symptoms of OC although make sure you only receive help from qualified professionals and check with your caregivers about the safety of any alternative treatments you are considering.
Relax whenever possible and take naps often as night-time itching can make sleep problematic.
After the Birth
Vitamin K will be administered by injection to your baby after birth to protect him from bleeding.
A few weeks post-birth you will have a follow-up liver function test to ensure you were suffering from OC. If the results are abnormal you will be referred to a specalist for further testing. You may also be scanned again to ensure you have no gallstones.
Your gp may advise against using contraceptive pills containing oestrogen and will advise an alternative.
More Pregnancy Complications
- Gestational Diabetes
- Carpal tunnel syndrome
- Placenta previa
- Morning sickness
- Varicose veins
- Stretch marks
- Depression (pre-natal depression)
- Childbed fever (puerperal sepsis)
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