Cholestasis primarily affects the liver, because this particular organ in some women is the most vulnerable towards the changes of the hormonal levels during pregnancy. The liver produces bile that after goes to the intestines by the bile ducts and is involved in digestion. The occurrence of the cholestasis is closely related to the reduction of the outlet of bile into the intestine. After that bile salts accumulate in the blood.
The main symptom is the itching which usually tends to intensify at night. It may even cause insomnia and fatigue. Often, the itching begins in the feet and hands and then spreads throughout the body. In some cases, the itching becomes so intolerable, that pregnant women start to itch till the blood comes out. Another symptom is jaundice. Itching disappears after the childbirth.
Who is at risk for cholestasis?
The prevalence of cholestasis depends on the country where a prospective mother lives. For example, in Chile, this disease is the most common. Whereas in European countries the disease affects less than 1% of pregnant women, except Poland and the Scandinavian countries.
If your family has had some cases of cholestasis, the probability that it will be in you, increases significantly. For example, if your mother or sister have been through this – you are likely to have too.
How to recognize cholestasis?
Itching during pregnancy does not always indicate cholestasis, it may be caused by some other factors, for example, by skin stretching. But in any case, it would be better that your physician checks out the presence of the disease.
Itching as a symptom observed in the last 10 weeks of pregnancy, but sometimes it starts much earlier.
Blood tests should include liver function tests and determination of bile acids. If the results of the tests are negative, and the itch is still in progress, the repeated analyses are performed. The need for a repetition of the analysis arises from the fact that in some cases itching occurs much earlier than the other clinical manifestations of cholestasis when analysis do not show anything.
Furthermore, it is recommended to undergo an ultrasound to detect the presence of gallstones, which may provoke the blockage of the bile ducts. In general, pregnant gallstones are extremely rare. But as cholestasis contributes to their appearance at the same time the presence of cholestasis gallstones is possible.
Can the cholestasis of pregnancy cause harm to the child?
The presence of cholestasis increases the likelihood of stillbirth by 15%. The baby may die due to the effects of bile acids that penetrate through the placenta or the death of a baby can happen because of the defeat of the placenta.
Treatment for cholestasis of pregnancy
Nowadays for the treatment of cholestasis 2 kinds of medicines are used. The greatest preference is given to medication called ursodeoxycholic acid (Ursosan) that helps to eliminate or weaken the itching, normalize the bile acids and restore the normal functioning of the liver.
Also, the treatment may be implemented by steroids. However, they should be used with great caution.
Women suffering from cholestasis significantly increase the risk of postpartum haemorrhage. This is explained by the fact that bile plays a significant role in the body’s absorption of the K vitamin which is consumed with the food and promotes blood clotting.
Therefore, in some clinics, pregnant women receive vitamin K daily until the very childbirth. This is to prevent the bleeding risk. Vitamin K can also protect your baby.
The key goal of therapy is preventing stillbirth. For this purpose, the birth of a child should be implemented right after the baby’s lungs become stronger and so that she could live outside the womb. The condition and development of the fetus should be monitored by repeated ultrasound examinations.
The most of the medics think that the optimal delivery time for women suffering from cholestasis is 35 to 38 weeks of pregnancy. In the time of a stimulation of labour during this period, the probability that the child will survive will be much higher than if you give a pregnancy last up to 40 weeks.
Can cholestasis occur in the next pregnancies?
The probability that a subsequent pregnancy in women will be accompanied by cholestasis is quite large (up to 80%).
What about itching?
Currently, there is no medical evidence to suggest that a diet can help in this case but, nevertheless, it makes sense to review your diet. It is desirable to reduce the consumption of fried and fatty foods, dairy products in order to facilitate the work of the liver, as well as to drink plenty of fluids.
How to relieve itching
To relieve itching, try these tools:
- Calamine lotion;
- Creams with calendula and chamomile;
- Wear loose, light clothing made of cotton;
- Avoid, if possible, high humidity and heat.
Additionally, you can ask for help to a certified homeopath, who will be able to choose the drugs that improve your liver functioning. But be sure to consult your doctor before you start additional or alternative treatment.
Try to calm down and relax. Use every opportunity to get some sleep, because sometimes the itching does not let you get enough sleep at night. Create the optimal conditions for normal sleeping. Try not to pay attention to your condition using any activities.
What will happen after the childbirth?
Some time after the childbirth, your baby may need some injections of vitamin K. If a newborn weighs more than 2.7 kg, she only needs the portion of vitamin K and nothing else. However if a child weighs less than 2.7 kg, she may be assigned to additional treatment under the supervision of neonatologists depending on the condition.