Obstetric Cholestasis..... An itch you can't scratch!
It’s just an itch….. Right??
Itchiness is a common occcurance during pregnancy. The skin on your tummy may become itchy due to the skin stretching to accommodate your growing baby. The skin on your feet and ankles may itch slightly if you are dealing with swelling. You may even be getting prickly heat, or your skin is more sensitive to products where it wasn’t before….. This is all so very NORMAL!!
I had a question from one of my antenatal mums yesterday. She was suffering from itching. All over her tummy. But specifically the palms of her hands. As a midwife, this sent up a little red flag. I recommended that she go and get her blood checked for Obstetric Cholestasis.
So, if you haven’t heard of Obstetric Cholestasis (or even if you have) read on…
What is it??
Obstetric Cholestasis is a disorder developed during pregnancy that affects your liver. It causes Bile Acids to build up in your blood and this predominantly causes itching of the skin.
On average it affects around 7 in 1000 women. So don’t panic, this is less than 1%.
What causes it?
Honestly, we don’t know. We have a pretty good idea. Researchers have found increased estrogen levels (always higher in pregnancy) can affect the way your liver functions and the result is obstetric cholestasis.
It may also be linked to your genes. With a higher percentage of Indian-Asian or Pakistani-Asian women developing the disorder.
Why is it a problem in pregnancy?
The itching tends to increase with the severity of the disorder. Itching can occur on the palm of the hands, soles of the feet, less commonly on the arms, legs, face and breasts. It can be relentless, an itch you can’t scratch and interferes with sleep, work, daily activities.
In rare cases, some women have proceeded on to develop jaundice. Jaundice occurs when the liver cannot break down bilirubin and it overflows in to the blood (causing a skin colour similar to Marge Simpson).
The risk to your baby is not to be ignored either. It has been linked to increasing the chances of your baby passing meconium (pooing) before birth. This is not necessarily a problem but can alter the path of your delivery.
There have been some studies which suggested that Obstetric Cholestasis is linked to stillbirth. This meant that most women with this condition are induced earlier than intended. However recent research shows that the rate of stillbirth is the same for women who do not have the disorder. So no panicking please!
How is it diagnosed?
Blood tests are taken to diagnose Obstetric Cholestasis.
They will do LFTs (liver function tests) to check if everything is working ok.
They will also check your bile acids to check the levels in the blood.
Finally a few other blood tests associated with the liver (such as your clotting factors) may be tested.
What is the treatment?
Ursodeoxycholic Acid (known as Urso) reduces the level of bile acids and helps improve liver function. This in turn can reduce the itching. Antihistamines can help with skin itching as well as ointments and lotions and cool baths.
Obstetric Cholestasis will return to normal and disappear after delivery of your baby.
Induction of labour...
Most Doctors, in pretty much any country will advise induction of labour for this condition. They will suggest it after completion of your 37th week of pregnancy. Always discuss it with your doctor and ask why they feel induction is necessary for your particular case! Always stay in charge of your care!!
They will more than likely want you to come to the clinic/hospital for more routine CTGs (monitoring) to check on baby too! Always stay in charge of your care!!
So, after all this information, what do I want you to remember?
Itching on the palms of your hands, soles of your feet, face and breasts is not normal and should be investigated.
Obstetric Cholestasis can be treated and managed so do not be scared of it.
Never think you cannot approach your midwife or doctor about this (it’s our job?)
Wishing you an itch free pregnancy…
The Fit midwife xx