What is Cholestasis? Take Pregnancy Itches Seriously

In most pregnancies, skin itching or even rashes occur, and most of the complaints are non-serious skin reactions due to pregnancy. It is a condition that does not harm the baby or the mother on its own, with insomnia and constant itching. Pregnancy-related cholestasis, on the other hand, is a dangerous situation for both mother and baby. As a physician, we must make the differential diagnosis.

Bile ponding, that is, cholestasis, is the accumulation of bile secretions in the liver and its inability to be eliminated from the body. May cause liver damage. Pregnancy-related cholestasis is more common in the late period, for example after 30 weeks. It is characterized by intense itching, especially in the hands and feet, but also in many other parts of the body, especially at night.

The cause of itching is the leakage of bile acids that have accumulated in the liver and could not flow into the gallbladder. Of course, itching is a distressing situation for the mother, but since the accumulation of bile in the liver causes damage to the liver, it creates a risk especially for the mother. On the other hand, since the intense bile acids in the blood will pass to the baby through the placenta, it may cause danger to the baby in the womb.

Babies who swallowed meconium-containing poop at birth are more common in cases with pregnancy-related cholestasis. Sudden infant deaths have been reported in progressive and poorly followed cases. In the mother, liver failure, especially coagulation disorder, may cause uncontrolled bleeding at birth or after.

The cause of pregnancy cholestasis or the mechanism by which it develops has not been determined yet. It is thought to be an adverse reaction of the maternal immune system to pregnancy. It is difficult to take action because the cause is not known exactly. However, it is more common in those with a family history, those who had the same complaint in a previous pregnancy, those with liver disease and twin pregnancies.

Blood tests help in diagnosis. Increased bile acids and impaired liver function are observed. Ultrasonography in pregnancy-related cholestasis does not give much information about the baby's condition. Since it carries the risk of rapid progression, it is recommended that the baby be delivered as early as possible to adapt to the external environment. In order to prolong the gestational week, we administer drugs that bind bile acids, vitamins, antihistamines, anti-itch drugs and, in some cases, cortisone treatment.

The most important step is not to miss that the itching is serious and to go to the differential diagnosis. Very close follow-up and regular repetition of blood tests are important. It is recommended that patients with pregnancy-related cholestasis be delivered early before term. After the birth, the problems in the mother pass very quickly and return to normal.

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