Is Delivery By 37 Weeks Necessary For Cholestasis Of Pregnancy?

Cholestasis of pregnancy is a liver disease that occurs during pregnancy. It happens when the bile from the liver does not travel to the digestive tract but, gets blocked and accumulated in the liver itself. The bile salts get collected in excess and ultimately enter the blood, causing an intense itching especially in the feet or palms. That said, itching can occur anywhere on the body and is especially extreme during the night.(1,2)

Is Delivery By 37 Weeks Necessary For Cholestasis Of Pregnancy?

Cholestasis of pregnancy poses an increased risk of stillbirths, especially towards the end of pregnancy, that is, the last trimester. The occurrence of stillbirths is much higher in women with cholestasis of pregnancy, as compared to other women. As the incidence of stillbirths is much more towards the third trimester, it is rational that an early delivery be attempted, as it will reduce the risk of stillbirth(3)

The focus of the treatment approach for cholestasis of pregnancy is to reduce itching and also to avoid any complications in the baby. The treatment approach includes-

Remedy For Itching- To pacify the extreme itching, your doctor may ask you to take the following measures-

  • Medicine called ursodiol helps to bring down the levels of bile salts in your blood. Some other medicines may also help relieve your itching, which can be taken on the advice of your doctor.
  • Drenching the areas affected by itching in lukewarm or cool water can help

Keeping A Tab On Baby’s Health- Cholestasis of pregnancy can lead to many serious complications if not actively managed. Close management and monitoring of the condition is required to ensure that the baby does not face any complications. This may include the following measures-

  • Performing A Nonstress Test- The nonstress test will help in monitoring the heart rate of your baby and also checking the heart rate during activity
  • Performing A Fetal Biophysical Profile- This test gauges your baby’s well-being. The movement of the baby, muscle tone amniotic fluid amount, breathing, etc. are monitored with the help of this test. These tests may help in reassuring the mother about the well-being of the baby. However, these tests cannot foresee whether there will be a preterm birth or any other complication related to cholestasis of pregnancy.
  • Inducing An Early Labor- Even if all these tests seem normal, your doctor may still feel it necessary to induce early labor as the possibility of stillbirth cannot be ignored at any given time.(4)

Lifestyle Changes And Home Remedies For Cholestasis Of Pregnancy

  • Home remedies can be tried, though they don’t promise relief from itching. They can still provide a soothing feeling.
  • In some women, taking a cool bath may reduce the intensity of itching
  • Some women may feel better with creams and lotions consisting of oatmeal, or an oatmeal bath
  • Applying an ice pack to the itchy part may relieve the intensity of itching in some women.(4)

Alternative Therapies For Cholestasis Of Pregnancy

There is not enough research into the alternative therapies for cholestasis of pregnancy. Hence, alternative treatment methods are generally not recommended by healthcare providers in this condition. However, if you wish to try an alternative therapy, it is best to consult with your doctor before starting any of those.(4)

Conclusion

Cholestasis of pregnancy is a condition of the liver that occurs usually during late pregnancy. It can lead to serious complications in both mother and baby. The commonest and most dangerous complication of this condition is a stillbirth or intrauterine fetal demise and is usually seen if early delivery is not taken care of, which is usually by 36 to 37 weeks. Hence, to avoid stillbirth, the doctor may decide to induce labor from 36 to 37 weeks of pregnancy.

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