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.
The exact cause is not known, but some causes may include:
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.
Treatment may relieve symptoms but does not cure obstetric cholestasis – the only cure is to deliver your baby. Treatment options include:
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.
You have a 45-90% chance of getting obstetric cholestasis this pregnancy – do inform your gynaecologist about your history as early as possible.
