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Cholestasis Of Pregnancy Causes, Symptoms, Diagnosis and Treatment

What Is Cholestasis Of Pregnancy?

Obstetric cholestasis (OC) is an uncommon pregnancy condition that affects the liver and leads to itchiness, sometimes intensely so.

Pruritis (itching) has long been considered to be a common symptom of pregnancy. The vast majority of times, itching is a minor annoyance caused by changes to the skin, especially that of the abdomen.

However, there are instances when itching is a symptom of cholestasis of pregnancy. This is usually most intense on the palms of the hands, and the soles of the feet, but can be widespread.

ICP occurs most commonly in the third trimester, but can begin at any time during the pregnancy

Other names for cholestasis of pregnancy include obstetric cholestasis and intrahepatic cholestasis of pregnancy.

For mothers, cholestasis of pregnancy may temporarily affect the way the body absorbs fat-soluble vitamins, but this rarely impacts overall nutrition.
For babies, the complications of cholestasis of pregnancy can be more severe.

  •     Cholestasis of pregnancy increases the risk of the baby being born too early (preterm birth).
  •     It increases the risk of meconium getting into the amniotic fluid that surrounds the baby. If a baby inhales meconium during delivery, he or she may have trouble breathing.
  •      There’s a risk of fetal death late in pregnancy.

Causes Of Cholestasis Of Pregnancy:

The causes of intrahepatic cholestasis of pregnancy are still not fully understood. Hormones and genetic factors are likely to be important in the pathogenesis of the disease.  A number of features of the disease suggest a link to hormones:

  •     It occurs in the third trimester at the time when hormone levels are at their highest.
  •     Twin and triplet pregnancies, which are associated with higher hormone levels, show a higher incidence of cholestasis of pregnancy.
  •     It resolves quickly after delivery, when placental hormone production ceases.
  •     Older high-dose estrogen oral contraceptive pills could cause features of cholestasis of pregnancy.

Factors that increase the risk of developing cholestasis of pregnancy include:

  •     A personal or family history of cholestasis of pregnancy
  •     A history of liver disease
  •     A twin pregnancy

Symptoms Of Cholestasis Of Pregnancy:

Signs and symptoms may include:

  •     Itching, in particular but not limited to that of the palms of the hands and soles of the feet, without presence of a rash
  •     Itching that increases in the evening
  •     Itching that does not respond favorably to anti-histamines or other anti-itch remedies
  •     Often, elevated LFT results as well as serum bile acid counts
  •     Darker urine
  •     Lighter stools
  •     Increased clotting time (due to possibly associated vitamin K deficiency)
  •     Fatigue
  •     Increased nausea
  •     Decrease in appetite
  •     Jaundice
  •     Upper right quadrant pain

Diagnosis Of Cholestasis Of Pregnancy:

To obtain a diagnosis of cholestasis of pregnancy there are two LFT and Serum bile acid test.
The liver function tests (LFTs) is a simple blood test, the results of which should be available by the next day. If the ALT level is elevated, this, plus pruritus of palms and soles, could be considered as potentially diagnostic of cholestasis of pregnancy but only with elevated bile acid levels.

The serum bile acid blood test for cholestasis of pregnancy is a quantitative measurement of bile salts. The results of this test often take longer to return, but the test is more specific for cholestasis of pregnancy.

Treatment Of Cholestasis Of Pregnancy:

While there is no cure for cholestasis of pregnancy and no way to guarantee a successful outcome, studies have shown a slightly better fetal and maternal outcome from administration of Ursodeoxycholic Acid, whereas Cholestyramine appears to only relieve itching.
If additional blood tests to check clotting function identify a problem, giving Vitamin K may help avoid the risk of hemorrhage at delivery.

By : Natural Health News

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