Cholestasis is a condition in which the normal flow of bile in the gallbladder is slowed or stopped resulting in itching and jaundices (yellowing of the skin, eyes, and mucous membranes).
However, this condition can initiate in early pregnancy cholestasis is more common in the last trimester of pregnancy and generally goes away within a few days after delivery.
Cholestasis occurs in about one woman out of 1,000 overall, and in multiple pregnancies. It has a high risk of recurrence in future pregnancies. This disease is also referred to as intrahepatic (in the liver) cholestasis of pregnancy and pruritus gravidarum (severe itching).
What causes cholestasis?
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. Byproducts 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 buildup of bile acids in the liver, which can spill into the bloodstream causing itching. Jaundice may also result when bilirubin levels build up.
How is cholestasis diagnosed?
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.
What are the symptoms of cholestasis?
The following are the most common symptoms of cholestasis. However, each woman may experience symptoms differently.
Symptoms may include:
- Overall itching, especially the palms of the hands and soles of the feet
- Benign 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 can resemble with other medical conditions. Always consult your doctor for a diagnosis.
Treatment for cholestasis
The treatment for cholestasis will be determined by your doctor depending upon:
- Pregnancy, overall health, and medical history
- Extent of the disease
- Tolerance for specific medications, procedures, or therapies
- Expectations for the course of the disease
- Your opinion or preference
The main aim of treating cholestasis is to lower down the itching and prevent complications. Itching can be easily treated with topical anti-itch medications or with corticosteroids.
At times, medicines are also used to help and 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.