Cholestasis Of Pregnancy: Causes, Symptoms, Risk Factors, Diagnosis, Treatment, Prevention and Complications

Intrahepatic cholestasis of pregnancy, or simply cholestasis of pregnancy, is a liver disease that can occur in late pregnancy. The sickness causes intense itching, but there isn't a rash. Itching mostly affects the hands and feet, though it can occur on other parts of the body as well.

Cholestasis associated with pregnancy can cause excruciating agony. But the potential issues are more worrisome, especially for your baby. Owing to potential complications, your physician might suggest an early delivery at 37 weeks.

Causes Of Cholestasis Of Pregnancy

The precise cause of cholestasis during pregnancy is unknown. Cholestasis causes a reduction in or cessation of bile flow. Bile is a digestive fluid that the liver produces that helps break down fats.

 Instead of travelling from the liver to the small intestine, bile builds up there. As a result, bile acids eventually enter the bloodstream. The symptoms and issues associated with cholestasis during pregnancy appear to be caused by increased bile acid levels.

Pregnancy hormones, the environment, and genetics could all play a role.

• Hormones: You feel more pregnant the closer your due date gets. This could cause a slowdown in bile flow.
• DNA: Sometimes the illness runs in the family. There have been identified particular gene changes that may be linked to pregnancy-related cholestasis.
• Environment: The specific environmental factors of risk are unknown, and it varies by place and season.

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Symptoms Of Cholestasis Of Pregnancy

The main symptom of cholestasis in pregnancy is intense itching. But there's not even a rash. Although itching can occur anywhere, it typically occurs on the soles of the feet or the palms of the hands. The itching might keep you awake at night and is typically severe at night.

The itching is most common during the third trimester of pregnancy, however it may sometimes begin earlier. It may seem more intense as your due date draws near. After your baby is born, the itching usually stops in a few days.

Other, less common signs and symptoms of cholestasis during pregnancy could be:

• The word "jaundice" refers to a yellowing of the skin and eye whites.
• Decrease in  appetite
• Greasy, pungent stools
• Vomiting

Also read: Vaginal Agenesis: Causes, Symptoms, Diagnosis, Treatment and Complications

Risk Factors Of Cholestasis Of Pregnancy

During pregnancy, the following factors may increase your risk of developing cholestasis:

• Pregnancy-related diarrhoea in individuals or their relatives
• History of liver damage or illnesses in the past, including gallstones and hepatitis C
• Having many children while pregnant at a later age—35 or older, for example—
• If you have a history of cholestasis, you are more likely to have the illness during a future pregnancy. It happens again in about 60–70% of females. This is what we call a recurrence. In severe circumstances, the likelihood of a recurrence can approach 90%.

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Diagnosis Of Cholestasis Of Pregnancy

To diagnose cholestasis related to pregnancy, your pregnancy care provider would usually:

• Ask about your symptoms and medical history.
• Conduct a physical assessment.
• To find out how much bile acids are in your blood and how healthy your liver is, get blood tests done.

Treatment Of Cholestasis Of Pregnancy

During treatment for cholestasis in pregnancy, the main goals are to minimise itching and protect your unborn child from harm.

Your prenatal care provider may recommend the following to alleviate intense itching:

• Utilising ursodiol, a drug that is prescribed (Actigall, Urso, Urso Forte). This drug helps lower the amount of bile acids in your bloodstream. Other drugs might also be available to lessen itching.
• Soaking irritated areas in water that is either cool or gently heated.

Before starting any itching medication, it is recommended that you see your prenatal care physician.

If you have cholestasis, pregnancy problems could occur. Your prenatal care provider may suggest close monitoring of your foetus during your pregnancy.

Observation may entail:

• Nonstressing Test: During a nonstress test, your prenatal care provider will take your baby's heart rate and the amount it raises with activity.
• The foetus's biophysical profile (BPP): This series of tests helps monitor the health of your infant. It provides information about the amount of amniotic fluid, heart rate, muscle tone, and breathing habits of your baby.

While these test results can provide reassurance, they cannot predict the risk of preterm birth or other complications associated with pregnancy-related cholestasis.

Even if the results of your prenatal tests are within normal ranges, your prenatal care physician may nevertheless recommend inducing labour before your due date. An early term delivery at 37 weeks may lower the risk of stillbirth. Vaginal birth is recommended if labour cannot be induced unless there are other medical reasons to perform a caesarean section.

Since a history of pregnancy-related cholestasis may increase the probability of symptoms recurring while using estrogen-containing contraceptives, other birth control methods are generally indicated. These include progestin-containing birth control pills, diaphragms and condoms, and intrauterine devices (IUDs).

Also Read: Uterus Didelphys(Double Uterus): Causes, Symptoms, Diagnosis, Treatment and Complications

Prevention Of Cholestasis Of Pregnancy

 There's no known treatment for pregnancy-related cholestasis.

Complications Of Cholestasis Of Pregnancy

It appears that difficulties arising from cholestasis related to pregnancy are caused by high blood levels of bile acid. The developing infant is especially vulnerable, even though issues in the mother are probable.

A mother's body's capacity to absorb fat may be temporarily altered by the sickness. Inadequate absorption of fat may lead to decreased levels of blood clotting components that are dependent on vitamin K. This is not a typical problem, though. Future liver problems are possible, however unlikely.

In addition, pregnant women with cholestasis are more prone to develop preeclampsia and gestational diabetes.

For newborns, cholestasis associated with pregnancy might have quite dire implications. These might include:

• Being born prior to due date is referred to medically as preterm delivery.
• meconium-induced respiratory problems. Metonium is the term for the green, sticky substance that typically accumulates in the developing baby's intestines. A mother may release meconium into the amniotic fluid if she has cholestasis.
• A late-pregnancy baby that passes away before delivery is referred to as a stillbirth.
• Given that complications could pose a serious risk to your unborn child, your pregnancy care provider may consider inducing labour before the scheduled delivery date.

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