Cholestasis of pregnancy is a condition in which the normal flow of bile in the gallbladder is slowed or stopped resulting in itching and jaundice (yellowing of the skin, eyes, and mucous membranes). Although it may begin in early pregnancy, cholestasis is more common in the last trimester of pregnancy and usually goes away within a few days after delivery. Cholestasis of pregnancy occurs in about one woman out of 1,000 overall, but it is more likely in Swedish and Chilean populations, and in multiple pregnancies. It has a high risk of recurrence in future pregnancies. It is also known as intrahepatic (in the liver) cholestasis of pregnancy and pruritus gravidarum (severe itching).
The gallbladder is an organ attached to the lower part of the liver. It serves as a holding reservoir for bile that is produced in the liver. Bile acids are important in the breakdown of fats in digestion. Waste products in the blood are converted to a part of bile called bilirubin.
It is thought that hormones in pregnancy affect gallbladder function, resulting in slowing or stopping of the flow of bile. This causes a build up of bile acids in the liver, which can spill into the bloodstream causing itching. Jaundice may also result when bilirubin levels build up.
Cholestasis may increase the risks for fetal distress, preterm birth, or stillbirth. It may also increase the mother's risk of postpartum hemorrhage (severe bleeding following delivery).
The following are the most common symptoms of cholestasis of pregnancy. However, each woman may experience symptoms differently. Symptoms may include:
Overall itching, especially the palms of the hands and soles of the feet
Mild nausea and discomfort in the upper right abdomen
Dark urine color
Light coloring of stools (bowel movements)
Jaundice (yellow coloring of skin, eyes, and mucous membranes)
The symptoms of cholestasis may resemble other medical conditions. Always consult your doctor for a diagnosis.
In addition to a complete medical history and physical examination, generalized severe itching without a rash is often the first clue to diagnosis. Blood tests for liver function, bile acids, and bilirubin often show changes which may also aid in the diagnosis.
Specific treatment for cholestasis of pregnancy will be determined by your doctor based on:
Your pregnancy, overall health, and medical history
Extent of the disease
Your tolerance for specific medications, procedures, or therapies
Expectations for the course of the disease
Your opinion or preference
The goals of treating cholestasis of pregnancy are to relieve the itching and prevent complications. Itching may be treated with topical anti-itch medications or with corticosteroids. Medication is sometimes used to help decrease the concentration of bile acids. Fetal monitoring tests may be used to check the well-being of the fetus. Babies of women with cholestasis are often delivered early (usually around 37 weeks) because of the risk to the fetus.