Cholestasis of Pregnancy

Cholestasis is a stopping or restriction of bile flow from the gallbladder into the intestine. It can be mild to severe. This problem usually happens during the final trimester of pregnancy. This condition occurs because the liver is not getting rid of its bile. The bile is part of the breakdown products of red blood cells. When these breakdown products (bilirubin) become elevated in the liver and spill into the blood, they produce jaundice. Jaundice is a yellowing of the skin. It is often seen first in the whites of the eyes. As the bilirubin becomes more elevated, it causes itching and sometimes a rash of the skin.

CAUSES

  • Having problems inside or outside of the liver (gallstones blocking the opening of the gallbladder).

  • During pregnancy, it may be due to the elevated estrogen in the blood.

  • A response to the estrogen in birth control pills.

  • Drug or alcohol use.

  • Certain types of anemia (low red blood cells) present before the pregnancy. Let your caregiver know if you have anemia.

  • Jaundice in pregnancy is also seen with severe toxemia, severe and continuous vomiting (hyperemesis gravidarum), and acute fatty liver of pregnancy.

  • Other causes of jaundice that should be ruled out are hepatitis, chronic liver disease (cirrhosis), autoimmune hepatitis, and severe infectious mononucleosis.

This problem is usually harmless. However, it can cause early(premature) birth and threaten infant health. This type of jaundice is similar to jaundice of the newborn. If bilirubin levels become high enough, it can cause mental retardation in the baby.

SYMPTOMS

  • Itching, mild to severe.

  • Jaundice.

  • Rash at times.

DIAGNOSIS

  • Increase amount of bilirubin in the blood stream.

  • The patient has yellow skin and the white of their eyes (jaundice).

TREATMENT

This problem disappears with delivery of the baby. Treatment is usually directed at controlling the itching. If the problem is severe and the jaundice reaches dangerous levels, labor may be induced or a cesarean section may be performed. This does not usually cause permanent liver damage in the mother. However, the cholestasis may occur in future pregnancies.

HOME CARE INSTRUCTIONS

  • Do not use drugs or alcohol.

  • Do not take any medication unless suggested by your caregiver.

  • Keep all follow-up appointments as directed. This is important for you and your baby's health.

  • Only use the creams and medications for the itching given to you by your caregiver.

SEEK IMMEDIATE MEDICAL CARE IF:

  • An unexplained oral temperature above 102° F (38.9° C) develops, or as your caregiver suggests.

  • Symptoms are not controlled by the medications or measures suggested by your caregiver. You seem to be getting worse.

  • You develop nausea, vomiting, or abdominal pain.

  • You develop a severe headache.

  • You develop vision problems (blurred or double vision).

  • You develop uterine contractions.

  • You develop vaginal bleeding.