Definition
Pregnancy cholestasis is a disturbance in the flow of bile from the liver to the gall bladder or duodenum during pregnancy. This leads to an increased concentration of bile acids in the blood. It usually occurs in the third trimester, i.e. approximately from the 26th week of pregnancy at every 500th to 1000th pregnancy.
The risk of developing a new pregnancy cholestasis in the second pregnancy is about 40 to 60%. The most important symptom is a pronounced itching that persists until the end of the pregnancy. The drug ursodeoxycholic acid can relieve the itching by improving bile acid excretion.
Causes of Pregnancy Scholestasis
The cause of pregnancy cholestasis is not yet clearly understood. It is believed that many factors interact to trigger this disease pattern. It is assumed that genetic and also external factors can play a role.
It is also discussed that increased sensitivity to the higher concentration of the pregnancy hormone estrogens during pregnancy can have an influence on the development of pregnancy scholestasis. At the level of liver cells, it has been found that a disturbance in the transport of bile acid from the liver cells to the bile ducts leads to the increased concentrations of bile acids in the blood. These elevated concentrations in turn trigger the symptoms described below.
Symptoms of Pregnancy Scholestasis
The leading symptom of pregnancy cholestasis is itching. In severe cases, jaundice (medical: icterus) may develop. This is characterized by a yellowing first of the dermis of the eye and later also of the skin, which is caused by the storage of a decomposition product of the red blood pigment.
In some cases, nausea and vomiting may also occur. Itching is the most important symptom of pregnancy scholestasis and is described by affected women as excruciating. It is believed that the increased concentration of bile acids in the blood causes them to be deposited in the skin. There they irritate nerve endings and thus trigger the usually severe itching. In many cases, this continues during the remaining pregnancy and is difficult to treat.
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