Cholestasis is a disease that is related with liver, and occurs only during pregnancy. It causes severe itching to the pregnant ladies, late in their pregnancies. It is also known as ICP, or Intrahepatic Cholestasis of Pregnancy. The condition is associated with abnormal flow of bile, due to increase in the amount of pregnancy hormones. It causes severe itching on hands and feet, without causing rashes. But, the itching is not limited to hands and feet alone, and can spread across the entire body.
Cholestasis can make the person extremely uncomfortable, and can also lead to complications for the mother and the child. And, it might also require early delivery of the child.
Symptoms of ICP
There are some common symptoms that are associated with Cholestasis of Pregnancy. Some of these include:
The itching occurs mostly on palms of the hands, or soles of the feet. Some women find itching almost everywhere. The itching intensifies during the night, making it difficult for the women to sleep. The itching problem mostly starts during the 3rd trimester, but might sometimes start earlier, as well. The problem becomes worse around the due date, and is at its peak around the time of delivery. The problem subsides substantially, once the baby is delivered.
Dark colour of urine
Another common symptom is the colour of the urine, which is darker in colour, as compared to normal.
Pain in upper right quadrant
One can feel a pain in the right upper quadrant.
Bowel movements are light in colour
The bowel movements are lighter or paler in colour, as compared to normal.
Exhaustion and fatigue
The person will feel unusually tired or fatigued.
Pregnancy is usually stressful and depressing for some women. But, with ICP, the depression is at a little higher level.
This is associated with the yellowing of skin, and eyes.
The lady might feel severe bouts of nausea, which are not related to morning sickness.
Lack of hunger
There might be a loss of appetite, as well, with lack of hunger, or no mood to eat anything.
Cholestasis can be bifurcated into 2 categories, extrahepatic, which happens outside of the liver, and intrahepatic, which happens inside of the liver.
As per the statistics, almost 1 out of every 1000 pregnant ladies, suffer from ICP. But, the problem is most common in Chilean and Swedish ethnic groups.
Causes of Cholestasis of Pregnancy
The hormones during pregnancy, fluctuate a lot, and it affects the functioning of liver, resulting in the slowing down of the bile flow. The gall bladder, which is responsible for holding the bile, produced in liver, is required for breaking down of fats during digestions. When the flow of bile in liver slows down, or gets stopped, it causes build-up of bile acids that can result in spilling into the blood stream.
The genes might also play an important role in this. If the disease runs in the family, then having it during one’s pregnancy, is imminent.
The diagnosis is done with the help of examining the complete medical history, and with the help of a physical examination. Also, blood tests are taken for evaluating the liver functioning. ICP is measured, when the total bile acids, are 10 micromo/L or above. The increase in the acids was attributed to estrogen initially, but as per recent studies, progesterone also contributes to this problem.
The following ladies face a higher challenge of getting cholestasis:
- Mothers, who carry multiples
- Mothers, having faced damages of their liver previously.
- And Mothers, whose sisters or mothers have suffered from this problem.
- Mothers, who have experienced cholestasis before, in their earlier pregnancies, have a 90% chance of getting it again in future pregnancies.
ICP might directly affect the babies. The babies might suffer from foetal distress, still-birth or pre-term births. The developing foetus inside the womb depends upon the mom’s liver for removing the bile acids from blood. So, if there is an increase in the bile of the mother, it might cause stress for the baby’s liver, as well. Women, suffering from Cholestasis should be supervised and monitored closely, and the labour should be induced as soon as the lungs of the baby have matured.
The treatment for Cholestasis of Pregnancy involves providing relief from itching. Some of these treatments involve:
- Applying topical anti-itch ointments, containing corticosteroids.
- Medicines for decreasing the concentration of bile acids
- Taking bath in cold or ice water, can also slow down the flow of blood in the body, as it reduces the temperature, and can give relief from itching.
- A steroid called Dexamethasone, can also be taken for increasing the maturing of the child’s lungs.
- Supplements for Vitamin K, can be taken by the mother before delivery, for preventing intra-cranial haemorrhaging.
- Milk thistle and Dandelion root are the natural substances, which are beneficial for the liver.
- Regular blood tests should be done for monitoring the liver functioning and the levels of bile serum.
But, before taking any kinds of medications on your own, consult the doctor. The doctor will actually decide the course of treatment, after considering the following things:
- The pregnancy, medical history and the overall health.
- The level and degree of disease
- The tolerance for specific procedures, medicines and therapies
Complications, due to Cholestasis, might occur in both mom and the baby. In the moms, the condition might affect the way of fat absorption. When the fat is absorbed poorly, it might result in a decrease in the level of Vitamin K dependent factors, which are involved in clotting of blood. But, such a complication is a rarity.
In the babies, the complications relating to ICP might be more severe. This could result in pre-term births, lung problems, and even stillbirths. As, the complications might become dangerous for the child, the mom might have to get into induced labour, even before the due date.
There is no way of preventing cholestasis of pregnancy. But, with suitable treatments, the problem can be easily treated.