Diagnosis of pregnancy cholestasis

The first step in the diagnosis of pregnancy cholestasis is a consultation with your doctor. Here the doctor will collect the symptoms and, if there is a suspicion of a bile stasis, he will also ask whether similar symptoms have already occurred in previous pregnancies. This is particularly important for further diagnostics, as up to 60% of pregnancy cholestasis recurs in subsequent pregnancies.

A definite diagnosis is now made by taking a blood sample and determining the bile and liver values in the laboratory together with the symptoms. The symptoms are often of varying severity and there are no early warning signs, so laboratory testing is the most important diagnostic tool. To diagnose pregnancy cholestasis through blood testing, so-called cholestasis parameters are determined.

These are gamma-glutamyltranferase and alkaline phosphatase. They are also greatly increased in other diseases associated with bile stasis. In addition, the liver enzyme alanine aminotransferase is measured, which is also often slightly elevated.

In addition, the direct bilirubin is elevated, which is the processed form of a breakdown product of the red blood pigment. An elevated value means that there is a disorder in the removal of bile acids. An important differential diagnosis of pregnancy cholestasis is hepatitis, i.e. inflammation of the liver caused by certain viruses. Therefore, it is necessary to determine additionally by laboratory chemistry whether the pregnant woman has been infected with one of these viruses and whether there is sufficient vaccination protection. Since the laboratory parameters mentioned are usually always determined in conjunction with other liver values, the blood test also provides information here.

Therapy of a pregnancy cholestasis

In a diagnosed pregnancy scholestasis, close monitoring of the mother and fetus is essential, as the risk of intrauterine fetal death (death of the child in the second half of the pregnancy in the womb) and premature birth is increased.Ursodeoxycholic acid (Ursofalk®) can be administered as a medication, which promotes the excretion of the patient’s own bile acids. Increased excretion can also improve itching. It is also a very safe drug during pregnancy and appears to reduce the rate of deaths and premature births.

Another drug that is used in some cases is colestyramine. It binds the bile acid in the intestines and makes its excretion easier. However, relevant side effects of taking colestyramine may occur due to a lack of fat-soluble vitamins (vitamins E, D, K and A).

Therefore, vitamin K should be given additionally. Symptom-relieving therapy against itching can be initiated with various medications, but the removal of excess bile acids is the main focus and is the most effective therapeutic approach against itching. Furthermore, an early delivery should be aimed for, although the exact time is controversial. In severe cases, however, delivery should take place no later than the 37th week of pregnancy.