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Obstetric Cholestasis in Pregnancy



Like most of you, I'm sure I wasn't alone in having never heard of Obstetric Cholestasis before (OC). For those of you who weren't aware, I was diagnosed with OC by a midwife who happened to notice that I was itching a lot during one of my scans (the main symptom of OC) and to cut a long story short she asked me a few questions, arranged a few tests, and days later I was booked in to be induced! I was induced 2 weeks early at 38 weeks as a precaution.

Obstetric cholestasis is a complication during pregnancy, albeit a rare one, which causes a persistent itch that usually develops during the last trimester of your pregnancy. This is caused by a build-up of bile acids in the bloodstream and disappears once you have had your baby. It affects fewer than 1% of pregnant women in the UK but requires medical attention due to a small increased risk of complications during your pregnancy.

Obstetric cholestasis (OC), also called intrahepatic cholestasis of pregnancy (ICP), is a potentially serious liver disorder that can develop in pregnancy. Normally, bile salts flow from your liver to your gut to help you digest food. In obstetric cholestasis, the bile salts don’t flow properly and build up in your body instead. There’s no cure for OC, but it clears up once you’ve had your baby. www.nhs.uk

Symptoms

Itching with no rash is usually the main symptom of obstetric cholestasis. It tends to appear during the final trimester of your pregnancy and can be anything from mild & irritable to severe & unbearable! Most women usually find that the itching intensifies at night and is generally more pronounced in the palm of your hands and the soles of your feet. The constant itching, especially at night, can leave you feeling exhausted and even sore. It may be of little comfort at the time but important to remember that the itching should disappear once your baby is born!

For me the itching began at 36 weeks and after a week of putting up with it, it became unbearable. I would carry around kitchen scrubbers so that I could constantly scratch my skin and wasn't able to stop even when my skin started bleeding. I used to drive James mad because I'd toss and turn at night unable to stop the itchy sensation and after a week of sleepless nights I knew I needed to see a doctor.

Further symptoms in some cases can also be jaundice, dark urine and pale bowel movements.

It is important to be aware of these signs and to seek advice if you are uncertain.

Treatment

In addition to the itching, OC also affects your blood's ability to clot. If bleeding occurs, you may find that it takes a lot longer to stop than usual. You may therefore be prescribed with Vitamin K during your pregnancy which will help to counteract OC's effects it has on your blood's ability to clot as Vitamin K plays an important role in healthy blood clotting.

You may also use creams which are safe to use during pregnancy, such as calamine lotion, as these will help to soothe and reduce any itching.

In addition to this, your doctor may take tests to monitor your condition and the function of your liver as well as an increased number of scans. These may become regular throughout the latter stages of your pregnancy to enable the doctor to monitor you closely each week or fortnight.

What are the dangers to my baby?

Evidence is not conclusive, but research suggests that there is an increased risk of babies to be born prematurely or even stillborn, however it is difficult to reliably know what an individual baby's risk of stillbirth is.

After 37 weeks,labour induction or caesarean section will be suggested due to the risk of stillbirth. A hospital birth will also be recommended to enable consultants to monitor your labour so it may not be possible or advisable to have a home birth. Your baby will be given continuous heart rate monitoring throughout your labour.

As I previously mentioned, I was booked in for an induction of labour at 38 weeks, only a few days after tests confirmed that I did indeed have OC. Although this was quite upsetting at first as I'd really wanted a water birth I knew it was right for me and my baby. Apprehensive and uncertain of what to expect, less than a mere 16 hours later our beautiful, healthy baby Lily was born weighing in at 7lb 9oz and all the troubles and worries of OC were long since forgotten.

Will I get it again?

More than likely yes... if you have had OC in a previous pregnancy then it is highly likely you will develop OC in future pregnancies. On the plus side, you will be aware of the condition and be able to inform your midwife or GP before symptoms arise so that they can monitor and treat your condition where necessary.

If you have been experiencing persistent itching in your pregnancy I urge you to get it checked out. Although the odds are that you are just experiencing what is a very common pregnancy symptom, it's always better to be safe and double check.

More information about obstetric cholestasis can be found on the NHS website and the Baby Centre website.

4 comments

  1. Oh bless you! I have heard about this before and always thought how unbearable it must be to have! Strange things pregnancy can do to your body. xx

    www.mattandannas.blogspot.com

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    1. It is so strange isn't it! The itching was a nightmare I have to admit, but it could always have been worse I guess xx

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  2. Poor you! I was tested for this during my first pregnancy as I got really itchy feet and hands one day, but the tests came back fine x

    Quite Frankly She Said - UK Beauty, Parenting & Lifestyle Blog

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    1. The thing with OC is that it can take weeks before the tests become back as abnormal so in a lot of cases you have to keep pushing for regular blood tests. Just something to be aware of for any future pregnancies :) The itching sucks doesn't it! x

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