Early Pregnancy

Obstetric Cholestasis

What is Obstetric Cholestasis?
This is a condition of pregnancy in which there is a slowing of the flow (stasis) of bile in the liver.  It is, therefore, sometimes called “intra-hepatic” (inside the liver) cholestasis of pregnancy. 
Is it dangerous?
It is of no danger to mother but may be very unpleasant.  However, there is some evidence that the baby does not like it as some pass meconium (the bowel contents).  If the baby inhales meconium at birth (meconium aspiration) it can irritate the baby’s lungs leading to a pneumonia.
What symptoms might I suffer?
Often the only symptom is itching.  This may be over the whole body or confined to the palms of the hands and soles of the feet.  The symptoms usually start only late in pregnancy. 
Bile is necessary for adequate digestion of fat and so more may be left in the bowel than usual.  This leads to light coloured motions which may float on water.  The slow passage of bile to the bowel causes a build-up in the blood and this may be seen as a yellow coloration of the whites of the eyes.  Some of the excess will pass out of the body via the kidneys giving a dark urine.
What causes this condition?
The cause of Obstetric Cholestasis is unknown.  It is fairly clear that hormones play a part.  We know, for example that women in their forties are more prone to gallstones than men.  Estrogen seems to produce thicker bile which will flow more slowly and (if kept in the gall bladder) tend to solidify.  Progesterone too might play a part as it tends to slow the rhythmic contractions (peristalsis) of muscular tubes in the body which move the contents along the tube.  Estrogen and, particularly, progesterone rise throughout pregnancy as their factory, the placenta (afterbirth) grows.  These hormones are also higher in a twin pregnancy and cholestasis is more common. 
Like most conditions, there are genetic factors.  A woman might inherit a particular way of making bile or other difference from other women which makes her more susceptible to cholestasis.
What treatment is used?
General Measures:  Keeping cool, even cold showers or ice buckets help some women temporarily.
Ursodeoxycholic acid:  This is a natural bile acid which has been used to relieve the itching with some success.
Vitamin K:  This is often low in people with liver or bile problems.  It is very important for blood clotting and so supplementation is ofted recommended.
Timing of delivery:  There has been some suggestion, in the past, of an increased risk of stillbirth.  We have found no real evidence for this and so our practice is often based more on the woman’s discomfort than the perceived risk to the baby. 

Further information and support can be obtained at:  www.ocsupport.org.uk

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