Cholestasis of Pregnancy
What is Cholestasis of Pregnancy?
Bile is a fluid made by the liver that helps to digest
fats. Cholestasis of pregnancy is a liver disorder in which the release of
bile from the liver is blocked by high levels of the hormones
estrogen and progesterone during pregnancy. The bile
builds up in the blood causing itching. Cholestasis of pregnancy usually
occurs in the second half of pregnancy, and affects about one in 200 pregnancies. Cholestasis of pregnancy is also called
intrahepatic cholestasis of pregnancy (ICP) and obstetric cholestasis.
Most women complain of itching. The itching usually begins on the palms of the hands and
soles of the feet. The itching tends to be worse at night. Although there is no rash as is seen with
pruritic urticarial papules and plaques of pregnancy (PUPPP), intense scratching
may leave multiple scrapes or abrasions. About 10% of women with cholestasis of
pregnancy may also develop jaundice (yellowing of the skin or whites of the eyes).
Dark urine and light colored stool (bowel movements) are uncommon
If you have any of the following you are at increased risk for
cholestasis of pregnancy
- A family history of cholestasis
- A history of cholestasis in a prior pregnancy
- A history of cholestasis with use of oral contraceptives
- You are presently carrying more than one baby (twins or triplets)
- This pregnancy is the result of in-vitro fertilization (IVF)
- You have hepatitis C
Contact your doctor if you develop intense itching or signs of
cholestasis of pregnancy.
Cholestasis of pregnancy is diagnosed by physical
your history, and performing blood tests to evaluate how well your liver is
working. Some blood tests that might be ordered to evaluate your liver
function include serum bile acids, alanine
aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP),
and prothrombin time (PT) .
There are many medications and health conditions besides
cholestasis of pregnancy that can cause itching and abnormal liver function
tests. So make sure to take any medication you have been using, and any medical
records your doctor may not have to your doctor's appointment.
The diagnosis of cholestasis of pregnancy is usually made if the following
- Elevated fasting bile acids greater 10 μmol/L (or other liver
Because some women may have
itching for weeks before abnormal liver function tests develop, your doctor
will often repeat the tests every 1 to 2 weeks if your tests are normal.
Cholestasis of pregnancy can occur together with other
diseases that cause similar symptoms. Your doctor may order more tests if
there is chance you might have another disorder of pregnancy such as
pre-eclampsia or HELLP syndrome.
Effect of Cholestasis On Pregnancy
Cholestasis of pregnancy increases
the risk for premature
delivery and stillbirth. Some studies have found an increased chance for
having a low birth weight baby if the mother has cholestasis of
pregnancy. In addition, bleeding in the mother may occur due to
poor absorption of vitamin K from the gut due to the lack of bile. The likelihood of having a complication appears to greatest for women with
very high levels of bile acids.
Ursodeoxycholic acid (Actigall, Urso); Usually 1000 mg or 15 mg /kg
per day in three divided doses is given to improve liver function and decrease
Calamine lotion and Diprobase®
cream may help soothe your skin
Vitamin K , 5 mg orally once daily or Parenteral vitamin K (phytonadione; AquaMephyton) 5 to 10 mg/d IM QD
may be prescribed in patients with an abnormal prothrombin time (PT)
Dandelion Root and Milk Thistle are natural substances that
are thought by some to be beneficial to the liver . However, there is not enough
scientific evidence to support the safe use of Dandelion Root or Milk Thistle
during pregnancy or breastfeeding at this time.
- Your baby's heart rate and movement will be
monitored two times per week or more using an electronic monitor starting at
the time cholestasis of pregnancy is diagnosed. This test is called the
Nonstress Test. The fluid around the baby is often measured at the
same time of the nonstress test.
- Early delivery at about 37 weeks' is recommended by some experts,
especially in severe cases of cholestasis, in order to decrease the chances of
- After delivery you should be seen by your doctor to make sure the
itching has gone away and your liver tests have return to their normal
- The risk of developing cholestasis again in
a future pregnancy is as high as 70 percent.
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