A. Obstetric cholestasis is a disorder that affects your liver during pregnancy. This causes a build-up of bile acids in your body.
The main symptom is itching of the skin but there is no skin rash. The symptoms get better when your baby has been born.
Obstetric cholestasis is uncommon. It affects about 7 to 15 in 1000 women.
A. The cause of obstetric cholestasis is not yet understood, but it is thought that hormones and genetic and environmental factors (for example diet) may be involved.
A. Obstetric cholestasis can be a very uncomfortable condition, but it does not have any serious consequences for your health.
A. The effects of obstetric cholestasis on your baby are still not clear:
A. You may be diagnosed with obstetric cholestasis if you have unexplained itching in pregnancy with abnormal blood tests (liver function and bile acid tests), both of which get better after your baby is born. It is a diagnosis that is made once other causes of itching and abnormal liver function have been ruled out.
Symptoms: Itching is very common in pregnancy, affecting 23 in 100 women (23%), but only a small proportion of those women will have obstetric cholestasis.
However, itching is often the first sign of obstetric cholestasis, often being worse at night and involving the palms of the hands and soles of the feet. Therefore, if you do have itching, it is important you tell your obstetrician.
Inspection of the skin: Your skin will be carefully examined to check that your itching is not related to other skin conditions, such as eczema. It is possible that you may have more than one condition.
Blood tests: You may be offered one or more blood tests to help diagnose obstetric cholestasis. These include:
Some women may have itching for days or weeks before their blood tests become abnormal. If itching persists and no cause is found, the LFTs should be repeated every 1–2 weeks.
Ultrasound scan: An ultrasound scan can check for liver abnormalities and gallstones.
A. You should have your baby in a well-equipped maternity unit, along with a neonatal unit. Depending upon your circumstances, you will be advised to have additional antenatal checks.
You are likely to have liver function tests, usually once or twice a week, until you have had your baby.
Additional monitoring of your baby may include monitoring your baby’s heart rate (cardiotocography) and ultrasound scans for growth and measuring the amount of fluid around your baby. Unfortunately, none of these monitoring tests is completely reliable in preventing stillbirth.
When you are in labour, you will be offered continuous monitoring of your baby’s heart rate.
A. There is no cure for obstetric cholestasis except the birth of your baby. Treatment may ease symptoms for most women. None of the treatments offered affects the outcome for your baby.
A. Treatments might include:
Even if your blood clotting is not affected, there may be a small benefit from vitamin K. There is very little up-to-date information that vitamin K is harmful for your baby in pregnancy. Therefore, you may wish to have a discussion with your doctor about whether you wish to take vitamin K or not.
Shortly after birth, your baby should be offered vitamin K, as are all babies.
A. You will have an opportunity to discuss the option of having labour induced after 37 weeks of pregnancy, particularly if your symptoms are severe or your blood tests are very abnormal.
Early induction (before 37 weeks) may carry an increased chance of caesarean section and an increased chance of your baby being admitted to the special care baby unit with problems of being born early. It is difficult to predict the small risk of stillbirth if your pregnancy continues beyond 37 weeks. Your obstetrician will discuss what is best for you and your baby in your individual situation so that you can make an informed choice.
A. Obstetric cholestasis gets better after birth.
However, you should have a follow-up appointment with a specialist of obstetric cholestasis 6–8 weeks after the birth of your baby. The purpose of your follow-up is to ensure that your itching has gone away and that your liver is working normally.
Continuing symptoms and abnormal liver function tests may suggest a different problem after all and you should then be referred to a specialist.
A. There is a high chance that obstetric cholestasis may happen again in a future pregnancy: 45–90 in 100 women (45–90%) who have had obstetric cholestasis will develop it again in future pregnancies.