What Are The First Symptoms Of Cholestasis Of Pregnancy & How Do You Test For It?

Cholestasis is a complication characteristic of pregnancy, which often occurs in the second trimester of pregnancy and is characterized by strong itching and jaundice throughout the body. Cholestasis develops from the middle to late pregnancy. Later, jaundice appears. Also, the stool may turn grayish-white. In addition, it is often said that itching becomes stronger at night.

Bile stasis is a condition in which the bile secretion mechanism of hepatocytes is inhibited and bile components stagnate in the blood. It is a relatively common liver disorder that occurs during pregnancy, and clinically itchy jaundice is present. Normal cholestasis due to hormonal changes is caused by exacerbation. Symptoms subside after childbirth but tend to recur when you become pregnant again or take birth control pills.(1)

What Are The First Symptoms Of Cholestasis Of Pregnancy?

In late pregnancy, it often develops with strong itching throughout the body, which extends to the palms as well as the trunk and extremities. Jaundice occurs following the onset of itching, but not all people have obvious jaundice.

Despite severe symptoms, the general condition of pregnant women is good, and most of the symptoms disappear within 24 hours after delivery.

Common symptoms include:

  • Bowel movements get pale coloring
  • Dark-colored urine color
  • Feeling exhausted and fatigued
  • No appetite.
  • Right upper quadrant pain (not due to gallstones)
  • Severe to moderate itching (affecting extremities more)
  • Suffering from depression(3)

How Do You Test For Cholestasis Of Pregnancy?

The examination of serum bile acid that measures the bile acid level in blood is probably the most effective method used for identifying pregnancies with cholestasis of pregnancy. Measurement of serum total bile acids in the blood shows a 10- to 100-fold increase in the case of this disease. Especially a substance called serum cholic acid is found to be elevated considerably. An ultrasound of the liver may be done to differentiate it from other obstructive jaundice.

Other blood tests known as the Liver Function Tests and the fasting serum bile acid test may also be used as confirmatory tests for cholestasis. If these examinations are negative, but the individual appears to have itches, these tests need to be repeated again.(4)

Effects On Pregnancy: It has been said that the effects on the fetus are more frequent than in healthy subjects, such as amniotic fluid turbidity, premature birth, fetal distress, and stillbirth. There are also reports that the amount of bleeding during delivery is higher than in healthy mothers.(5)

Treatment And Management: If the symptoms are mild, no special treatment is required. However, when itching is severe, people may take cholestyramine, a drug used to reduce the absorption of cholesterol from the digestive tract and reduce bile acid synthesis.

Cholestyramine causes impaired vitamin K absorption, so mothers and babies need vitamin K supplementation. Also, if you have a history of gestational cholestasis of pregnancy, please note that oral contraceptives cannot be used. Antihistamines are used for pruritus (severe itching). Vitamin K may be given to prevent bleeding. The disease does not usually require special treatment because of its good prognosis.(5)

The Root Cause Of Pregnancy Cholestasis

It has been speculated that bile stasis may be triggered by pregnancy and other causes, and that competition may occur during the processing of bilirubin and bile acids with female hormones.

Female hormones increase with pregnancy. The main lesion is cholestasis, without hepatocellular necrosis or inflammatory cell infiltration. In addition, most cases of cholestasis caused by the use of drugs that prevent pregnancy have the disease or pruritus in the past (the patient). During pregnancy, jaundice is indicated secondary to pruritus, especially in the later stages. Less than a month after giving birth, pruritus usually improves. However, it tends to recur in subsequent pregnancies.

Viral hepatitis also causes jaundice during pregnancy. Although pruritus in pregnancy does not cause jaundice, it is classified as a subtype of reproductive cholestasis of pregnancy.

The hereditary potential has been reported, but the exact cause of cholestasis has not yet been elucidated. The presence of a gene that increases the sensitivity of the female hormone estrogen is thought to be involved in cholestasis in the liver. In such cases, the same symptoms occur with birth control pills.(2)

References:

  1. Brouwers L, Koster MP, Page-Christiaens GC, et al. Intrahepatic cholestasis of pregnancy: maternal and fetal outcomes associated with elevated bile acid levels. American journal of obstetrics and gynecology. 2015;212(1):100. e101-100. e107.
  2. Williamson C, Geenes V. Intrahepatic cholestasis of pregnancy. Obstetrics & Gynecology. 2014;124(1):120-133.
  3. Gabzdyl EM, Schlaeger JM. Intrahepatic cholestasis of pregnancy. The Journal of perinatal & neonatal nursing. 2015;29(1):41-50.
  4. Dixon PH, Williamson C. The pathophysiology of intrahepatic cholestasis of pregnancy. Clinics and research in hepatology and gastroenterology. 2016;40(2):141-153.
  5. Diken Z, Usta IM, Nassar AH. A clinical approach to intrahepatic cholestasis of pregnancy. American journal of perinatology. 2014;31(01):001-008.

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