Cholestasis of pregnancy

Diagnosis

In order to diagnose cholestasis of pregnancy, the prenatal care provider typically undertakes the following procedure:

• Physical examination: The healthcare provider will assess and ask about the symptoms and any medical history.
• Blood test: They would order blood tests to assess the concentration of bile acids in the blood and to evaluate the liver’s functionality.

The diagnosis is typically confirmed through tests if the total bile acids measure 10 micromoles per liter or higher. Throughout the remaining duration of the pregnancy, patient might undergo periodic blood tests to monitor the levels of bile in their bloodstream.

• Prothrombin time test: This examination is conducted to evaluate the blood’s clotting ability.
• Imaging test: The healthcare provider may order ultrasound to assess the bile ducts and liver.

Treatment

The goals of treating cholestasis of pregnancy are to alleviate itching and prevent complications for your baby.

To ease itching: Make sure to consult your prenatal care provider before starting any medication for itch relief. Your prenatal care provider may recommend:

• Taking a prescription medicine that helps lower bile acid levels in your blood.
• Soaking itchy areas in cool or lukewarm water.

Monitor your baby’s health closely: As cholestasis of pregnancy could lead to pregnancy complications. Your prenatal care provider might suggest the following for monitoring your baby during pregnancy:

• Nonstress testing: This assesses your baby’s heart rate and its response to movement.
• Fetal biophysical profile (BPP): This set of tests monitors various aspects of your baby’s well-being, including heart rate, movement, muscle tone, breathing, and amniotic fluid levels.

However, while these tests can provide reassurance, they can’t predict the risk of preterm birth or other cholestasis-related complications.

Early delivery might be recommended: Even if prenatal tests show normal results, your prenatal care provider might advise inducing labor before your due date, typically around 37 weeks. This early-term delivery can help reduce the risk of stillbirth. Vaginal delivery is preferred through labor induction unless specific reasons necessitate a cesarean section.

Future birth control: A previous history of pregnancy-related cholestasis could elevate the risk of symptom recurrence with estrogen-containing contraceptives. Hence, alternative birth control methods are typically advised. These options encompass progestin-based contraceptives, intrauterine devices (IUDs), and barrier methods like condoms or diaphragms.