Cholestasis during Pregnancy

[mumtobee]

Hi All,

Lately i had been having some trouble with this itchy skin. Had an appointment with a private doctor yesterday(i am registered and regular to public hospital only). He says it could be Cholestasis, some liver disease, and wanted me to check with the public hospital here during my next visit(the coming monday). I looked up on the internet for this disease and now am pretty much scared and paranoid as it uses big terms like jaundice, pre term and still births. I have had my blood test previously at the public hospital which came out to be normal(although not for this reason) and also told them about the itchyness. They dint seem to be bothered much and told me to get back when it becomes severe.. I dont know if what i am going through is severe/ normal / nothing at all.. but too worried at this moment. So before i go to the hospital, did anyone of you have it . if so what was the treatment and is it this scary as the internet projects it to be..could this really harm the baby.. currently at 32 weeks and 2 days
Help!!

 

[thanka2]

Hi mumtobee,

I had gestational cholestasis of the liver--likely had it with both pregnancies but was diagnosed as such in my second pregnancy. I also went to my private doctor as the itching was so intense and nothing they gave me helped--none of the strongest topical creams or internal medicines at all decreased it. I thought I was going to scratch myself to death.

It's not so much a "liver disease" as it's just a sign your liver is overloaded. So, your liver starts to release bile salts into your bloodstream which causes the intense itching. It's like gestational diabetes or eclampsia in pregnancy in that as soon as you give birth it goes away and the only cure for it is literally just to give birth.

They need to check your blood. If your levels are high enough you will be induced at 33 or 34 weeks likely to give birth as this is safest for baby. If your levels aren't that high you'll just be toughing it out for the rest of your pregnancy. My levels weren't at a critical level so I went full-term with my baby and she was born healthy, had absolutely no jaundice or other problems.

This is something to take seriously--just as eclampsia would be. But, it's not something to be scared of. Go to the public hospital but make sure you take a note along with you from your doctor referring you for the cholestasis blood test. This is a rare blood test that is not ordered very often because it's expensive--my doctor told me they use the university labs in order to process the blood and therefore he couldn't just order the blood test from another lab for me--you have to go through the public system in HK to get it done. It's just a simple blood draw. Explain you symptoms and show any scratch marks you have (I had TONS on my legs and stomach). The doctors should take you seriously if you come with a referral from your doctor--if you walk in there on your own and say, "Hey, I think I have cholestasis" they're going to tell you, "Were you reading too much on the internet, honey?" Generally most docs don't know much about it and they don't take a "little bit of itching" very seriously so you need someone to back you up.

But, don't worry, mumtobee....just do the test and find out what your levels are and that will determine whether you must induce in a couple of weeks or whether you can go full term. All the best to you!

PS: However, if you have cholestasis...even slightly...this is probably an indication that you may have other underlying liver issues. I just recently found out that I do and cholestasis in pregnancy (quite rare) is just one indicator that I've had this problem for quite some time. So, it's a good idea to have further blood tests done later.

 

[mumtobee]

Thankyou so much Thanka2. I was reading your other post about the same and that u had asked someone too about it. But was disappointed to see no reply. I shall get the referral from my private doctor asap. I was always under the impression that probably my bile count is too low as (till this morning) i have been throwing up only bile in the morning. Will get this test done asap. and about the itchyness, i do not have the marks as such and as u have mentioned i have not been scratching myself that hard. although now that i am talking abt it makes me want to scratch. its usually in the night and sometimes in the afternoon. but when it starts thats when i feel like peeling off my skin. just twice or thrice in a day.. is that severe????

 

[thanka2]

Thankyou so much Thanka2. I was reading your other post about the same and that u had asked someone too about it. But was disappointed to see no reply. I shall get the referral from my private doctor asap. I was always under the impression that probably my bile count is too low as (till this morning) i have been throwing up only bile in the morning. Will get this test done asap. and about the itchyness, i do not have the marks as such and as u have mentioned i have not been scratching myself that hard. although now that i am talking abt it makes me want to scratch. its usually in the night and sometimes in the afternoon. but when it starts thats when i feel like peeling off my skin. just twice or thrice in a day.. is that severe????

Hi mumtobee,

I think the fact that I received no responses when I posted indicated the rarity of the condition...if I had posted about gestational diabetes or preeclampsia I would have certainly received replies. But, the more I read, the more I found that this condition may not indeed be "rare" but just under-diagnosed. A lot of babies who are stillborn may indeed be stillborn because of obstetric cholestasis but as most women have some sort of itchiness in pregnancy (usually due to skin stretching) it is usually not taken seriously.

For me, the itchiness came and went but was worst in the evening and at night--especially at night--this is one of the hallmarks of the condition, actually. I felt like my skin was "crawling"....horrible feeling. And I was on different creams--the strongest they could safely give me in pregnancy as well as some pills and NONE of it even relieved 1% of the symptoms. That's also an indicator...if none of the meds provide relief it's definitely more than something external because of your skin stretching. The itchiness was worst on my legs. But, liver health really reflects in the condition of skin, actually...they're very related.

You won't know for sure what level of severity the condition is until you get your bloodwork back. I was pretty sure I was on my way to being induced because I had severe itching...so much so that one nurse commented, "Did a cat get hold of your legs, woman?!" But, I was under the threshold. I hope you don't have to be induced and that whatever meds they give you will help. I just took to taking baths in oatmeal...that was the only thing that even provided temporary relief and moisturized with acqueous cream as it was one of the few things that didn't make the problem worse. I had been using natural food-grade oils up until that point but even those created more itchiness.