Obstetric cholestasis

Mild itching is common in pregnancy because of the increased blood supply to the skin. In late pregnancy, the skin of the abdomen is stretched and this may also cause itchiness. Itching can, however, be a sign of obstetric cholestasis (OC). OC is a liver condition during pregnancy where there is a build-up of bile acids in the blood. This article covers:

How common is obstetric cholestasis in pregnancy?

Obstetric cholestasis symptoms

Can obstetric cholestasis cause harm to the baby?

How is obstetric cholestasis treated?

How may labour and birth be affected?

Will there be any problems after birth?

Further information

How common is obstetric cholestasis in pregnancy?

OC affects less than 1% of all pregnancies in the UK, but certain factors may make a difference:

• It is more common in women expecting twins, triplets or more.
• Mothers, daughters and sisters of women who have had OC will have a higher than average risk of also being affected when pregnant.
• It is more common in certain parts of the world. For example, in some countries in South America, especially Chile and Bolivia, up to 1 in 20 pregnant women develop the condition.

If you have OC in one pregnancy, you have a higher chance that it will occur in futre pregnancies.

Obstetric cholestasis symptoms

Typically, symptoms of OC are felt in the last third of pregnancy. However, it sometimes develops earlier in pregnancy.  The main symptom is persistent itching, usually without any signs on the skin, such as a rash. The itching is likely to be worst on the palms of the hands and the soles of the feet, and feels worse at night. The itch can become severe and may affect your sleep, concentration and mood.

You should see your doctor if:

• the itching becomes severe, particularly on your hands and feet,
• you develop jaundice (yellowing of the whites of the eyes and skin), or
• you get itching and a severe rash.

A blood test to measure liver function and levels of bile acid can confirm if you have obstetric cholestasis. You may also have a test to check how your blood is clotting, as the condition can cause a lack of vitamin K which is needed for the clotting process.

Can obstetric cholestasis cause harm to the baby?

There is an association of spontaneous premature labour, foetal distress and, in severe caes, stillbirth associated with obstetric cholestasis. Generally these cases have occurred only if a severe condition is left untreated. You may be advised to have extra antenatal checks to monitor the progress of your baby carefully.

How is obstetric cholestasis treated?

There is no cure for obstetric cholestasis and the symptoms will go once you have the baby. However, if the itching is at a distressing level, you can take steps to relieve the feeling. This may include using a mild moisturising cream to relieve dryness of the skin. It is also helpful to make sure you keep cool, especially at night. Wearing loose clothing may help.

You may be offered medication to help reduce the build-up of bile salts in the blood and antihistamine to relieve the itching.

Vitamin K supplements may also be suggested by your doctor as your levels of vitamin K are often lower in people with liver and bile problems.

How may labour and birth be affected?

If you have obstetric cholestasis in pregnancy the midwives and doctors looking after you are likely to recommend frequent checks to ensure your baby is well. They may want to discuss with you the possibility of inducing labour slightly early, as the risk of problems can increase slightly after about 36-37 weeks. For this reason too, you may be recommended to have continuous foetal monitoring in labour. 

Will there be any problems after the birth?

The itching symptoms of obstetric cholestasis will disappear after birth. OC is not thought to cause permanent liver damage. However, if you have had the condition in one pregnancy there is a greater possibility you will suffer from it again in other pregnancies.

Further information

NCT's helpline offers practical and emotional support in all areas of pregnancy, birth and early parenthood: 0300 330 0700.  We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

OCSupport UK is a group set up to help families affected by obstetric cholestasis. It provides support and information to women who have, or who may have, the condition, and their families, and also aims to keep up-to-date on the most recent research into the condition.

NHS choices gives some information on the signs and symptoms of obstetric cholestasis, and where to get more help.