Cholestasis of Pregnancy

About this topic

Bile is a kind of salt made in your liver. The bile normally flows into your bowels. The bile helps break down food or fats that you have eaten. Sometimes, the bile salt does not leave your liver as is normal. This is called cholestasis. Then, extra bile salts leak into your blood. ‚
During pregnancy, the condition is called cholestasis of pregnancy or COP. You may feel itchy most of the time. You may itch anywhere on your body. Most often you will feel itchy on your hands and feet. The itching most often starts in the last 3 months of your pregnancy, but can start at any time though. You may itch more at night and the itching may be very intense. After you have your baby, the itching will go away. Your liver will go back to normal again. ‚
Sometimes, COP may not cause any serious problems. Other times, problems may be serious enough to hurt you or your baby. You may have problems like: ‚

Too much bleeding when you give birth
Problems absorbing vitamins A, D, E, and K
COP with another pregnancy

Your baby may: ‚

Be born early
Have a higher chance for disability
Have an abnormal heart rate
Be born dead

Be sure you and your doctor work together. This will help to monitor your health and your babys health closely. ‚

What are the causes?

Doctors do not know the exact cause of COP. Some possible causes are changes in your hormones or something in the environment. There may also be something in your genes that makes this more likely to happen. ‚

What can make this more likely to happen?

COP is more likely if you: ‚

Are pregnant with more than one baby
Used in vitro fertilization (IVF) for pregnancy
Have a history of liver damage or hepatitis
Have a history of heavy alcohol use
Have had COP before or have a family history of COP

What are the main signs?

Itching, especially on the hands and feet
Dark urine color
Light color of bowel movement
Yellow eyes or skin (jaundice)
Tiredness
Loss of appetite
Low mood
Pain on the upper right part of the belly
Upset stomach and throwing up

How does the doctor diagnose this health problem?

Your doctor will take your history and do an exam. The doctor will check both you and your baby. The doctor will: ‚

Ask about the color of your urine and stool
Look at your skin to see if you have a rash
Listen to your babys heartbeat
See and check your baby's movements
Check your baby's growth and health

The doctor may order: ‚

Blood tests ¢ ˆ ’ Used to check how well your liver is working and measure the levels of bile salts in your body
Ultrasound ¢ ˆ ’ To check if some other health problem is causing your signs. An ultrasound is also done to check your baby's heartbeat and growth.
Amniocentesis ¢ ˆ ’ To check your baby's gestational age and growth

How does the doctor treat this health problem?

Your care will be based on your signs. The doctor will work to prevent more problems.
Your doctor will give you drugs, creams, and ointments to help with itching.
The doctor may do tests to check your baby. One test may be to see if your babys lungs are ready to breathe on their own. Sometimes, the doctor will want you to have your baby early if your condition is very serious. This may prevent some problems with your baby.

Are there other health problems to treat?

COP may affect your ability to clot blood. As a result, you may have a high risk of heavy bleeding after you give birth. ‚

What drugs may be needed?

The doctor may order drugs to:
- Help ease itching
- Lessen the amount of bile salts
- Help blood clot
- Help with swelling
Your doctor may also give your baby an injection to help blood clot and protect the baby from bleeding.
Your doctor may suggest you take extra vitamin K each day to help lessen the chance to develop postpartum bleeding. Your doctor may also give you multivitamins. This may help avoid poor nutrition due to low vitamin absorption.

Will there be any other care needed?

Take extra care when taking a bath or shower.
- Use lukewarm water and limit bath or shower time to 5 to 10 minutes.
- Use only mild and unscented soaps and bath products.
- Apply moisturizing products to keep your skin moist. Use water-based moisturizers only.
Stay away from things that may bother your skin such as household cleaners, detergents, aftershave lotions, gasoline, and other liquids.
Wear loose clothes made of cotton. Avoid clothes made of wool or synthetic fabrics. Use cotton slip covers on bedding or furniture to avoid skin irritation.
Do not cover your body with bed sheets when you sleep at night. Remove bedding and linens, if possible.
Do not scratch or rub skin, if possible. Try gently patting or tapping instead. Keep your fingernails trimmed and short to avoid damage to the skin.
Use a cool compress on your skin. Dip a cloth in cold water and put directly on your itchy skin. This may help ease itching.
Avoid stressful situations. Try to relax. Do yoga or meditation.
Have a low-fat diet and drink more water. Ask your doctor about your diet plan.

Where can I learn more?

American Pregnancy Association ‚
http://www.americanpregnancy.org/pregnancycomplications/cholestasispregnancy.html ‚
NHS Choices ‚
http://www.nhs.uk/conditions/pregnancy-and-baby/pages/itching-obstetric-cholestasis-pregnant.aspx#close ‚

Consumer Information Use and Disclaimer

This information is not specific medical advice and does not replace information you receive from your health care provider. This is only a brief summary of general information. It does NOT include all information about conditions, illnesses, injuries, tests, procedures, treatments, therapies, discharge instructions or life-style choices that may apply to you. You must talk with your health care provider for complete information about your health and treatment options. This information should not be used to decide whether or not to accept your health care providers advice, instructions or recommendations. Only your health care provider has the knowledge and training to provide advice that is right for you. ‚

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