”Some women experience a very severe itching in late pregnancy. The most common cause of this is cholestasis”

Emobileclinic Trending Topic: Cholestasis

Cholestasis is defined as a decrease in bile flow due to impaired secretion by hepatocytes or to obstruction of bile flow through intra-or extrahepatic bile ducts. Clinically, cholestasis is any condition in which substances normally excreted into bile are retained. The serum concentrations of conjugated bilirubin and bile salts are the most commonly measured.
Some women experience a very severe itching in late pregnancy. The most common cause of this is cholestasis, a common liver disease that only happens in pregnancy. Cholestasis of pregnancy is a condition in which the normal flow of bile in the gallbladder is affected by the high amounts of pregnancy hormones.

Causes
Pregnancy hormones affect gallbladder function, resulting in slowing or stopping the flow of bile. The gallbladder holds bile that is produced in the liver, which is necessary in the breakdown of fats in digestion. When the bile flow is stopped or slowed down, this causes a build-up of bile acids in the liver which can spill into the bloodstream.

 Symptoms
Itching, particularly on the hands and feet
Dark urine color
Light coloring of bowel movements
Fatigue or exhaustion
Loss of appetite
Depression
Jaundice (yellow coloring of skin, eyes, and mucous membranes)
Upper-Right Quadrant Pain
Nausea

 Vulnerable group
The following women have a higher risk of getting cholestasis during pregnancy:
Women carrying multiple pregnancies
Women who have previous liver damage
Women whose mother or sisters had Cholestasis

 Diagnosis
A diagnosis of cholestasis can be made by doing a complete medical history, physical examination, and blood tests that evaluate liver function, bile acids, and bilirubin.
Implications on the baby
Cholestasis may increase the risks for fetal distress, preterm birth, or stillbirth. A developing baby relies on the mother’s liver to remove bile acids from the blood; therefore, the elevated levels of maternal bile cause stress on the baby’s liver. Women with cholestasis should be monitored closely and serious consideration should be given to inducing labor once the baby’s lungs have reached maturity.

 Available treatment
The treatment goals for cholestasis of pregnancy are to relieve itching.
Some treatment options include:
Topical anti-itch medications or medication with corticosteroids
Medication to decrease the concentration of bile acids such as ursodeoxycholic acid
Cold baths and ice water slow down the flow of blood in the body by decreasing the temperature
Dexamethansone is a steroid that increases the maturity of the baby’s lungs
Vitamin K supplements administered to the mother before delivery and again once the baby is born to prevent intracranial hemorrhaging
Dandelion Root and Milk Thistle are natural substances that are beneficial to the liver
Bi-weekly non-stress tests which involve fetal heart monitoring and contraction recordings
Regular blood tests monitoring both bile serum levels and liver function
Risk of the Mother getting Cholestasis In another pregnancy
It is nearly impossible to know whether a woman will experience cholestasis in future pregnancies. Some sources claim that women who have had cholestasis of pregnancy have up to a 90% chance of having this repeat in future pregnancies, but the research is not conclusive.



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