Cholestasis of Pregnancy
What is cholestasis of pregnancy?
Cholestasis of pregnancy is a condition in which the normal flow of bile in the gallbladder is slowed or stopped resulting in itching and jaundice (yellowing of the skin, eyes, and mucous membranes). Although it may begin in early pregnancy, cholestasis is more common in the last trimester of pregnancy and usually goes away within a few days after delivery. Cholestasis of pregnancy occurs in about one to two women out of 1,000 overall, but it is more likely in Swedish and Chilean populations, and possibly in multiple pregnancies. It has a high risk of reoccurrence in future pregnancies. It is also known as intrahepatic (in the liver) cholestasis of pregnancy and pruritus gravidarum (severe itching).
What causes cholestasis of pregnancy?
The gallbladder is an organ attached to the lower part of the liver. It serves as a holding reservoir for bile that is produced in the liver. Bile acids are important in the breakdown of fats in digestion. Waste products in the blood are converted to a part of bile called bilirubin.
It is thought that hormones in pregnancy affect gallbladder function, resulting in slowing or stopping of the flow of bile. This causes a build up of bile acids in the liver, which can spill into the bloodstream causing itching. Jaundice may also result when bilirubin levels build up.
Why is cholestasis of pregnancy a concern?
Cholestasis may increase the risks for fetal distress, preterm birth, or stillbirth. It may also increase the mother's risk of postpartum hemorrhage (severe bleeding following delivery).
What are the symptoms of cholestasis of pregnancy?
The following are the most common symptoms of cholestasis of pregnancy. However, each woman may experience symptoms differently. Symptoms may include:
dark urine color
light coloring of stools (bowel movements)
jaundice (yellow coloring of skin, eyes, and mucous membranes)
The symptoms of cholestasis may resemble other medical conditions. Always consult your physician for a diagnosis.
How is cholestasis of pregnancy diagnosed?
In addition to a complete medical history and physical examination, generalized severe itching without a rash is often the first clue to diagnosis. Blood tests for liver function, bile acids, and bilirubin often show changes which may also aid in the diagnosis.
Treatment for cholestasis of pregnancy:
Specific treatment for cholestasis of pregnancy will be determined by your physician based on:
your pregnancy, overall health, and medical history
extent of the disease
your tolerance for specific medications, procedures, or therapies
expectations for the course of the disease
your opinion or preference
The goals of treating cholestasis of pregnancy are to relieve the itching and prevent complications. Itching may be treated with topical anti-itch medications or with corticosteroids. Medication is sometimes used to help decrease the concentration of bile acids. Vitamin K may also be used if blood clotting factors are abnormal. Fetal monitoring tests may be used to check the well-being of the fetus. If cholestasis of pregnancy endangers the well-being of the mother or fetus, then an early delivery may be necessary.
I don't know if elevated bilirubin necessarily means that you'll suffer with ICP later in your pregnancy. If so, the good news is that you' ll be prepared for the itchies if you get them!
I got the itchies around 30 weeks during my first pregnancy. I thought I would go crazy itching - it was debilitating! They did go away after delivery. It wasn't until my second pregnancy (and the itchies started again!) that I searched the internet and found this condition on my own! The doctor thought I was crazy until the test results came back. It seems like 6 weeks is early - the earliest onset I had was at 26 weeks.
I tried Bendryl and corticosteroids - no relief. Actigal was a miracle! It got the itchies under control within days!
I had a non-stress test every week from 30+ weeks. They induced at 37 weeks. That was just to be on the safe side. Glad we did! Our third child was jaundiced as a newborn and had to be under the special light for a week. Other than that, no problem.
I had my gallbladder removed after my third pregnancy. I was curious if maybe a bad gallbladder played into this condition. Also, when I went back on the pill, the itchies came back. While my husband and I were trying to decide what birth control option would be best for us since the pill wasn't anymore, I got pregnant with our fourth child. Gallbladder or not, I still got the itchies, but for whatever reason, it was late in my pregnancy this time.
Hope you enjoy a happy, healthy, itch-free pregnancy!
I also had ICP with all my 3 pregnancies...I am now preg. with my 4th @ 6 wks 4 days. I feel like I'm already itchy! It got worse with each pregnancy...absolutley excruciating! I itched until I bled...it was terrible and nothing would take it away.
The earliest onset I had was about 28 weeks, but I've heard of early onset cholestasis through the Itchy Moms support group. I think my onset will be much earlier this time, just due to how I feel already.
Nothing helped my itching, not even Urso...the only thing that helped was delivering at 36 weeks :) The worst part of my labour was not the pain it was the extreme itch. I had to give blood and do non-stress tests at the hospital every 2 days for the last month of my pregnancy.
Just keep an eye on yourself and ask lots of questions! good luck mama :)
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