Introduction and causation
Cholestasis is an uncommon liver disorder of pregnancy affecting about 1% of women, usually occurring beyond 28 weeks of pregnancy. Its exact cause is not well understood, but it is thought to be due to sluggish flow of bile from the liver to the bowel, due to the high levels of oestrogen caused by the pregnancy slowing the flow down.
This leads to a build-up of toxins like bile acids, bilirubin and liver enzymes which leak into the mother’s blood stream.
Cholestasis of pregnancy leads to an intense itchy sensation, especially of the hands and feet, and it can extend to the rest of the body, but there is no rash. This itch causes significant discomfort, and affects sleep and general functioning.
Some women with cholestasis can feel nauseated and can occasionally vomit. Up to 20% can become mildly jaundiced and may notice their urine to become quite dark and the stools pale.
The diagnosis is made by history, examination and blood testing to check liver function and also the level of bile acids in the blood stream. Blood tests to check the blood’s ability to clot will also be needed, often prior to labour. If blood clotting mechanisms are compromised, they can be treated by giving Vitamin K.
Management involves controlling symptoms with anti-histamines and skin treatments to try and reduce itch. In more severe cases of cholestasis or pregnancy, a drug called Ursodeoxcholic Acid can be used with good results to settle itch and normalize liver enzyme levels.
Close surveillance of the mother’s blood tests is important as well as surveillance of baby. Induction of labour at 37-38 weeks is also considered appropriate as the risk of stillbirth is increased in this condition.