What is Obstetric Cholestasis?posted by: Catriona
This month I would like to talk about Obstetric Chlolestasis (OC), a rare but serious condition that can develop during pregnancy (about 1 in 100).
What is OC?
Normally, bile salts flow from the liver into your digestive system to help you digest food. When you have OC, the bile salts don’t flow properly and build up in the body instead. Unfortunately, there is no cure for OC but the condition does clear up after the baby is born. If you have had OC in a previous pregnancy, you are more like to develop it again. It does seem to run in some families, although women with no family history do develop the condition. It is also more common in women of Indian or Pakistani origin.
What are the symptoms?
The main symptom is severe itching, all over the body, usually with no rash. The itching can be unbearable, often at night with affected areas including the hands and feet. (Women can get itchy skin in pregnancy however, without having OC). Other symptoms include darkening of the urine, yellowing of the skin and the whites of the eyes (jaundice) and pale bowel movements.
What are the risks?
Obstetric Cholestasis has been linked in some studies to an increased risk of premature delivery and stillbirth. There is however, no reliable way to work out exactly what the chances are of a stillbirth as each individual case is different. However, because of the risk, you may be advised to have an induction of labour or caesarean section at or around 37 weeks of pregnancy. Home birth would not be advised and you would be best cared for in hospital by an obstetric-led team.
Diagnosis and Treatment
At the beginning of your pregnancy, your midwife will have seen you for a “booking” appointment. She will have asked you about your own past medical and obstetric history and also about your family history. This appointment is really important as a good history can help to identify your risk of developing Obstetric Cholestasis. For example, if you or a family member has had it before.
If you develop any of the above symptoms, then a Liver Function (LFT) blood test will help to make the diagnosis. Once the diagnosis is made, then these blood tests will be repeated and monitored regularly until your baby is born. If the LFT’s remain within normal limits but you continue to itch, then they may be repeated weekly. If the LFT’s continue to be abnormal then early delivery of the baby may be advised.
Creams and lotions can help to reduce the itching and although there are some medicines which can help to reduce the bile salts, we are still unsure of their safety in pregnancy. You may be offered a vitamin K supplement as OC can affect the absorption of this vitamin, which is required in normal blood clotting.
Can I avoid it?
Unfortunately the answer is no, but having regular antenatal appointments with your midwife or obstetrician throughout your pregnancy can help to make an early diagnosis of the condition, thereby reducing the risks.
Visit The Royal College of Obstetricians and Gynaecologists