Cholestasis of pregnancy

 

Cholestasis is a Greek word chole which means “bile” and stasis meaning “still”. There are several names for this kind of condition such as; obstetric cholestasis, intrahepatic cholestasis of pregnancy or ICP.

This kind of health condition usually arises during the third trimester, when the concentration of the pregnancy hormone is at its highest level. It is a liver disturbance that happens during pregnancy.

It affects the standard flow of the digestive fluid of the bile which is coming from the liver. The bile acids are the chemicals that in the bile of the liver that assists digesting fats. If you have cholestasis or ICP, it means that the bile flows are slow and builds up in the bloodstream.

Once it is build up in the bloodstream, it will trigger itching particularly in the hands and feet. This kind of health condition does not usually cause any worry for the mother’s future health but it may cause potentially complications for the baby.

Several kinds of cholestasis

  1. Short term cholestasis or acute cholestasis. It is the one that suddenly arises.
  2. Long term cholestasis or chronic cholestasis. It is the disruption in the bile excretion on the liver.
  3. Extra hepatic cholestasis. This is the kind of cholestasis that occurs outside area of the liver.
  4. Intra hepatic cholestasis. Yes, this is the kind of cholestasis that occurs in the outside area of the liver.

Signs and symptoms of cholestasis of pregnancy

  1. Often, it the only symptoms that can be instantly noticed by woman who experiences cholestasis of pregnancy. The itching will usually increase in degree or severity until your doctor gives you treatment or until you deliver your baby. It can be constant or recurrent. It varies from one woman to another woman sometimes it begins in the palm of the hands, legs, arms, feet, soles of the feet, and even all over your body.
  2. Dark urine. Not every woman will have this kind of symptom but just so you know in case it shows. Because of the biochemical reactions that happen during cholestasis of pregnancy, you may have a darker color of urine. It can be either you are dehydrated or you have cholestasis of pregnancy. Either way, you need to inform your doctor once you have this kind of symptom. Some even reported that they have pale stools.
  3. Pain in the upper right quadrant. Some patients that experience intrahepatic cholestasis reported that they have symptoms of pain on the right side of their right ribs and some even mention that they have pain in the back below their right shoulder blade. Patients who had this kind of symptoms describe the pain as very debilitating and very uncomfortable. The feeling that as if the baby inside is putting a lot of pressure against their ribs.
  4. This kind of symptoms of cholestasis is very rare but it does occasionally occur to few. So if you notice that your skin or eyes are pale, make sure to seek medical advice.
  5. Overly fatigue. Although this kind of feeling is very normal during pregnancy, cholestasis can also result fatigue because of the role of the liver in your metabolism. Fatigue can be the result of stress, malabsorption of the minerals and other vitamins in the body, and lack of sleep.
  6. Early labor. Early delivery is risky but it is more likely to happen if you are suffering from cholestasis.
  7. Other symptoms may be mild depression, nausea, and loss of appetite.

Possible causes of cholestasis pregnancy

There is still so much to discover about the causes of cholestasis but researchers are recently probing hormonal, environmental, and genetic factors.

Pregnancy week by week
  • Hormonal factors. Progesterone and estrogen are the pregnancy hormones that have a significant effect on the ability of the liver to transport chemicals, particularly bile acids. The flow of the bile acids is significantly being reduced because of the pregnancy hormones which cause the bile acid to build up in the blood that eventually causes cholestasis of pregnancy.
  • Genetic factors. Cholestasis of pregnancy shows that it extends in the families. It is identified to have several gene mutations.
  • Environmental factor. Although the reason is quite not clear yet, there are many women discovered to have cholestasis of pregnancy during the cold winter months. This incident suggests that there is truly an environmental factor for this health conditions, they say that the lack of sunlight exposure or diet change may be the contributing factor.

Chances of acquiring cholestasis pregnancy

  1. Only about one to two pregnancies in 1000 suffer cholestasis of pregnancies in America and 5.7% of it is Latinas. If you are a descendant of a Chilean or Scandinavian, you are more at risk of getting obstetric cholestasis, since it is most common in those populations.
  2. Women who are carrying twins or multiples are also at a higher risk of acquiring cholestasis of pregnancy.
  3. Pregnant women who undergone IVF or fertility treatment also shows to be more risky of having this kind of health condition.
  4. Women who have or had damage in their liver may be more possible to develop cholestasis of pregnancy.
  5. If you have a sister or if your mother had this kind of medical condition history.

Possible complications of untreated cholestasis of pregnancy

  1. Meconium passage. Meconium is the kind of substance typically stored in the baby’s intestines. It comes out of the body of the baby during their first stools which is thick, dark green, and sticky. But because of fetal distress, it is sometimes expelled thru the amniotic fluid before birth or sometimes during labor. If that happens and the baby absorbs the contaminated liquid, it will bring the baby in to a great danger as it can bring respiratory issues.
  2. Fetal distress. It is a condition where the fetus is being compromised during labor. It can occur when there is an abnormal rhythm of myocardial contraction, decreased movements, high or low heart rate, meconium passage, and late decelerations in fetal heart rate.
  3. Preterm labor. Cholestasis pregnancy is associated with a considerable number or preterm birth. In fact, studies show that around 60% of preterm deliveries are because of this health issue.
  4. Maternal hemorrhage. Because cholestasis of pregnancy decreases the ability of the body to absorb fat-soluble vitamins like vitamin A, D, and K, it leads to Vitamin K deficiency. That puts the mother to a risk of postpartum hemorrhage or maternal intra. That is the reason why the doctors are prescribing Vitamin K supplements to their patients to avoid this kind of complication.

How will having cholestasis of pregnancy affect the baby?

  • It may just cause a severe itching to the mother but it can be very dangerous for the baby since all the spare bile will have the possibility of being strain on the baby’s liver.
  • The baby has the risk of being born earlier than expected. Premature babies are prone to acquire numbers of diseases as they grow old.
  • The risk of inhaling meconium during birth which will give the baby a hard time to breath.
  • Fetal death also happens during late pregnancy if the expectant mother has this kind of health condition.

How is cholestasis of pregnancy being diagnosed?

If you feel that you have the symptoms of cholestasis of pregnancy, make sure to have your blood test as soon as possible especially if you are on your late pregnancy. Efficiency is crucial when being tested to confirm if you really have this condition. The reason is, the bile acids can reach the placenta and affect the baby. Note that this particular even causes many stillbirths. Other reasons are:

  1. The blood test needed for cholestasis of pregnancy exam will take one week or longer to see the result.
  2. Bile acids have the capability to increase within a short period of time.
  3. The medication will take one to three days or longer before it can reduce the bile acids.

These reasons above are just some of the reasons why it is crucial not to delay getting the following test necessary to confirm the health condition:

  1. Fractionated bile acid blood test. It has the most sensitive indicator capable to identify if there is a growth in the levels of bile acids. It is not a common type of test and sometimes even your doctor and nurses may be unsure of how to administer the test but they can call the laboratory which they are working with to ask for help.
  2. Liver function test or LFT. The bile acids irritate your liver and when that happened your liver will release enzymes into your bloodstreams. That enzyme will be measured thru Liver Function Test also known as Liver Panel. This kind of test is not reliable, that is why it very essential to have both test conducted, particularly the Fractionated Bile Acid Blood Test.

Treatments available for cholestasis of pregnancy

  1. Ursodeoxycholic Acid. It reduces the bile acids in the bloodstream. It reduces the level of bile acids in the amniotic fluid and umbilical cord blood. Some studies show that this medication can significantly reduce itching. It protects the baby form having irregularity in heart rates and it also reduces the possibility of stillbirth.
  2. Vitamin K. Cholestasis impaired the capability of the body to absorb the fat-soluble vitamins which will lead to Vitamin K deficiency. Your doctor will give you prescription of Vitamin K to ensure that you are getting enough. Your baby will also receive injectable Vitamin K right after delivery.
  3. Several types of steroids to relieve itching and help to improve the function of your liver.

Work with your health care provider very closely to keep you and your baby safe. I hope this article is useful to you. Good luck with your pregnancy. It may be hard at times but everything is worth it. May the force be with you!!