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Cholestasis of pregnancy

Cholestasis of pregnancy occurs in late pregnancy and triggers intense itching, usually on the hands and feet but often on many other parts of the body.

Cholestasis of pregnancy can make you intensely uncomfortable but poses no long-term risk to an expectant mother. For a developing baby, however, cholestasis of pregnancy can be dangerous. Doctors usually recommend early delivery.

The term "cholestasis" refers to any condition that impairs the flow of bile — a digestive fluid — from the liver. Pregnancy is one of many possible causes of cholestasis. Other names for cholestasis of pregnancy include obstetric cholestasis and intrahepatic cholestasis of pregnancy.

Symptoms Causes Risk factors Complications

Intense itching is the predominant symptom of cholestasis of pregnancy. Most women feel itchy on the palms of their hands or the soles of their feet, but some women feel itchy everywhere. The itching is often worse at night and may be distressing enough that you can't sleep.

The itching is most common during the third trimester of pregnancy, but sometimes begins earlier. It may feel worse as your due date approaches. Once your baby arrives, however, the itchiness usually goes away within a few days.

Other less common signs and symptoms of cholestasis of pregnancy may include:

  • Yellowing of the skin and whites of the eyes (jaundice)
  • Nausea
  • Loss of appetite

When to see a doctor

Contact your pregnancy care provider promptly if you begin to feel persistent or extreme itchiness.

What causes cholestasis of pregnancy is unclear. There may be a genetic component, as the condition sometimes runs in families and certain genetic variants have been associated with it.

Pregnancy hormones also may play a role. Bile is a digestive fluid produced in the liver that helps the digestive system break down fats. It's possible that the increase in pregnancy hormones — such as occurs in the third trimester — may slow the normal flow of bile out of the liver. Eventually, the buildup of bile in the liver allows bile acids to enter the blood stream. Bile acids deposited in the mother's tissues can lead to itching.

Factors that increase the risk of developing cholestasis of pregnancy include:

  • A personal or family history of cholestasis of pregnancy
  • A history of liver disease
  • A twin pregnancy

Some of these factors may have to do with heredity, and all probably have to do with increased levels of pregnancy hormones. After you've had the condition once, the risk of developing it during a subsequent pregnancy is high. About half to two-thirds of women experience recurrence of cholestasis of pregnancy.

For mothers, cholestasis of pregnancy may temporarily affect the way the body absorbs fat-soluble vitamins, but this rarely impacts overall nutrition. Itching usually resolves within a few days of delivery, and subsequent liver problems are uncommon — although cholestasis is likely to recur with other pregnancies.

For babies, the complications of cholestasis of pregnancy can be more severe. For reasons not well-understood, cholestasis of pregnancy increases the risk of the baby being born too early (preterm birth). It also increases the risk of meconium — the substance that accumulates in the baby's intestines — getting into the amniotic fluid that surrounds the baby. If a baby inhales meconium during delivery, he or she may have trouble breathing. There's also a risk of fetal death late in pregnancy. Because of the potentially severe complications, your doctor may consider inducing labor around the 37th week of pregnancy.

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