Cholestasis of pregnancy, why does it occur?

Intrahepatic cholestasis of pregnancy causes intense itching due to the accumulation of bile in the liver during the third trimester. It resolves after childbirth, although it may recur in future pregnancies.

Intrahepatic cholestasis of pregnancy is a disease of unknown cause but associated with hormonal, environmental and hereditary factors that is presented during the third trimester of pregnancy and that resolves spontaneously after childbirth.

It was first described by a German obstetrician at the end of the 19th century. It affects 1 or 2 in every 100 pregnancies and curiously it is more frequent in South America, and can reach a 15% incidence in certain parts of Chile and Bolivia. Curiously, it is more common in winter months than in warm months, confirming that there are associated environmental factors..

Why does it occur?

In pregnant women with a genetic predisposition, the flow of bile to the intestine slows downwhich causes its accumulation in the liver. As a consequence, bile products increase in the blood as they are not eliminated properly and the liver becomes irritated by the retained bile.

What symptoms does it cause?

The main symptom is predominantly nocturnal itching of the skin which begins in the palms of the hands and soles of the feet and progresses until it becomes generalized.

Diagnosis

The diagnosis is confirmed by analytical tests that show a progressive increase in bile acids—substances secreted by the gallbladder—and liver enzymes in the blood. In some cases, this alteration of liver function can cause jaundice, manifested by yellowing of the skin and the whites of the eyes. They can also appear nausea, vomiting and discomfort in the upper right part of the abdomen, due to inflammation of the liver. In the most severe cases, when the flow of bile is completely blocked, the urine takes on a dark color and the skin and mucous membranes become yellowish, while the stool becomes pale and greasy due to the lack of bile pigment.

If you have recognized any of these symptoms and do not know their origin, it is important that you go to your doctor. In MAPFRE Health Insurance you will find great specialists who will diagnose your ailment.

CALCULATE YOUR PRICE

Predisposing factors

There are some factors that have to do with its presentation, more common at older agethe greater the number of previous pregnancies, in twin pregnancies and it occurs more in women with a family history or history of this pathology as there is a genetic predisposition.

The treatment is based on trying to relieve the itch with lotions or antihistamine drugs that, in addition to calming the itch, cause drowsiness and will also help with the associated irritability and insomnia.

How to act?

One has to closely monitor fetal well-being and bile acid levelsto terminate the pregnancy when possible, as it is the true treatment of this pathology. In the postpartum period, surveillance continues but the condition returns to normal in the first weeks.

It is repeated in subsequent pregnancies in 40-60% of cases and, as there is an associated hormonal cause, in some women contraceptive hormonal treatment can favor the reappearance of symptoms, which is why it is not recommended for women who have suffered cholestasis during pregnancy.

Not to be confused with…

It is very important to differentiate it from other pathologies of pregnancy that cause pruritus, characteristically cholestasis does not cause skin lesions, rashes or papules, at most lesions due to scratching, and the rest of the pruritic diseases of pregnancy, such as gestational herpes, polymorphous pregnancy eruption or prurigo, present with papules or skin rashes.

What you should know…

• Intrahepatic cholestasis of pregnancy is an alteration of bile flow that appears in the third trimester and resolves spontaneously after childbirth.
• Its main symptom is nocturnal itching without skin lesions, and it is diagnosed by an increase in bile acids and liver enzymes, being more common in women with a genetic predisposition or multiple pregnancies.
• Management consists of relieving symptoms, monitoring the fetus and terminating the pregnancy when necessary, since delivery is the definitive solution; The condition may recur in subsequent pregnancies.