Obstetric Cholestasis

What is obstetric cholestasis?

This is a liver condition in pregnancy which causes raised bile acids in your body. Bile acids are needed for digestion and absorption of fats and fat-soluble vitamins in the intestines.

Why has obstetric cholestasis happened to me?

The exact cause is not known, but some causes may include:

• Hormonal changes in pregnancy
• Genetic factors: more common in certain ethnic groups (e.g. South Asian, South American etc) and run in families

What are the symptoms of obstetric cholestasis?

• Itching on your palms and soles of feet: tends to be intense, persistent and worse at night
• Jaundice: yellowing of skin and eyes, pale stools, dark urine

What tests do I need for diagnosis?

Your gynaecologist will need to take a detailed medical history and examine your skin to ensure that your itch is not related to other skin conditions e.g. eczema. You will need blood tests to check your liver function and bile acid levels – these may need to be repeated as your itch may start before your blood tests turn abnormal. Your liver function tests will need to be monitored weekly until delivery.

In some cases, you may need to be referred to a liver specialist to rule out other liver conditions.

What are the risks for my baby?

• Increased risk of baby passing motion in your water bag (meconium-stained liquor)
• Increased risk of needing premature delivery and induction of labour
• Small increased risk of stillbirth

What is the treatment for obstetric cholestasis?

Treatment may relieve symptoms but does not cure obstetric cholestasis – the only cure is to deliver your baby. Treatment options include:

• Skin creams/ointments 
• Antihistamines (for itch)
• Ursodeoxycholic acid: this medication reduces your bile acid levels and helps with itch. It may or may not reduce the risk of stillbirth 
• Vitamin K: this is only in cases where your blood clotting function has been affected 

Can I carry my baby to term if I have obstetric cholestasis?

If your liver function remains stable and there are other pregnancy concerns, you will be offered induction of labor from 37 weeks of pregnancy with the aim of a vaginal birth (unless there are other indications for C-section). Your labour will be monitored closely. Inducing labour from 37 weeks aims to balance the risks of prematurity and needing a C-section (due to early induction) versus the small increased risk of stillbirth. 

You will need to repeat blood tests to check that your liver function has returned to normal at least 10 days after delivery, at your postnatal check with your gynaecologist. 

Your gynaecologist will discuss appropriate birth control methods for you, as you will be advised to avoid estrogen-containing contraception.

I had obstetric cholestasis in my previous pregnancy. Will I have it again this pregnancy?

You have a 45-90% chance of getting obstetric cholestasis this pregnancy – do inform your gynaecologist about your history as early as possible.