Obstetric Cholestasis (OC), or intrahepatic cholestasis of
pregnancy (ICP) is a complication of pregnancy that affects the
liver. Most places and doctors seem to say it is uncommon but I
had OC during my first pregnancy and the amount of women who
also had OC in the same ward I was in surprised me, so I feel it
is probably not as uncommon as it once was.
OC appears to be
caused by an over sensitivity to pregnancy hormones. Bile is
produced in the liver and normally it flows down the bile ducts
into the intestines where it helps digest foods. If you have OC
the flow of bile into the intestines is reduced and so bile
salts build up in your blood.
What Causes Obstetric Cholestasis?
It is unknown what causes OC and
more research is being carried out to try to find out the
causes. It is thought to be an hereditary condition so if your
mother or sisters were affected then you may find you will
suffer to. You may also be more at risk with OC if you are
carrying multiples or have had previous liver damage. There also
appears to be a strong geographical link with a higher
prevalence in Scandinavia and South America. However, some
doctors are worried that lower rates in other countries could be
down to poor diagnosis and with many cases going undetected.
am going to be helping with research into this condition at
Hammersmith hospital in London, if you would like more
information or would like to help also please visit the
following website, where you will also find an OC Chat room as
well as more information: http://www.ocsupport.org.uk/.
What are the Symptoms of Obstetric Cholestasis ?
Although OC has been reported in early pregnancy
it is far more common for it to develop in the third trimester
(final 3 months of pregnancy). The main symptom of OC is
itching, which can be worse at night, as a result insomnia and
fatigue can occur. The itching often begins on the palms of the
hands and/or the soles of the feet. Some women scratch so much
they cause their skin to bleed.
Other symptoms you may develop could include:
The itching completely disappears within a couple
of weeks of giving birth (my symptoms disappeared almost
immediately). If your symptoms persist you should contact your
doctor for further help.
What is the risk to my baby?
The risk of having a stillborn baby is 15%
greater in women with OC than for other women, though it is not
fully understood why this is. The baby may die due to bile acids
crossing the placenta or as a result of being suddenly deprived
of oxygen, perhaps due to placental problems.
Elevated levels of bile acids have also been
proven to increase the incidence of meconium ( babies first poo,
made up of bile, mucus, cells from the bowel wall, and amniotic
fluid) being passed whilst still inside and therefore increasing
the risk of sudden stillbirth.
be carried out to check the babies lungs are mature enough for
delivery and to survive outside the womb. At present most women
with OC will be induced at 35-38 weeks. In cases where bile
acids do not respond to treatment then it may be necessary to
deliver the baby earlier than lung maturity to protect the child
from the risk of stillbirth.
Obstetric Cholestasis Diagnosed?
If you tell your doctor or midwife about the
itching then they will usually consider OC. It is important to
remember not all itching will be caused by OC, as the skin
stretches some women can experience itchy skin. For OC to be
confirmed a liver function test and a bile acid test should be
carried out. A bile acid test is not routinely available in most
hospitals at present and will usually be sent away to a
specialised hospital, because of this results will often take a
week to 10 days to return. The bile acid test is the most
specific test for OC but due to the length of time it takes to
receive the results doctors will usually begin treatment before
the results are confirmed.
If you have OC it is important to have a blood
test to check how your blood is clotting before the birth as you
may need extra vitamin K.
You may also be given an ultrasound to check on
the liver and to rule out other liver conditions.
Your pregnancy may involve having regular tests
to monitor your baby’s heartbeat, ultrasound scans and blood
tests. Some women have to stay in hospital to make sure that
the baby is progressing well. I had to stay in hospital on and
off for 2 weeks, then after that had to return every day to have
the baby monitored.
About Future Pregnancies?
Reported recurrence rates really tend to vary
some research states there is about 60% chance that future
pregnancies will also be affected by OC, however others suggest
there is a 90% chance of recurrence.
If you would like to email me about OC and my
experience then you may do so via our feedback page. I had OC in
my one and only pregnancy and have a healthy little girl.
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