Obstetric cholestasis (OC) is an uncommon pregnancy condition that affects your liver and makes you feel itchy, sometimes intensely so. Doctors still don’t know what triggers OC but they do know that OC happens as a result of the way your body uses bile, a liquid produced in your liver. Bile helps to break down food, in particular fats, in your gut.
Normally, bile flows down a tube (the bile duct) into your intestines but when you have OC, less bile flows into your intestines. That means bile acids (also sometimes referred to as bile salts) start to build up in your body.
The main symptom is severe generalised itching (all over your body), usually without a rash, most commonly in the last four months of pregnancy. Some women get itching and a severe rash. The itching is sometimes more pronounced on the palms of your hands and the soles of your feet. It can also be intense and worse at night. There is not a rash, although you might scratch so hard that you break your skin.
A few women with OC develop jaundice, which makes you feel generally unwell. Jaundice causes your skin to be yellow-tinged, because of the changes happening in your liver. It can also turn your wee dark and make your poo pale.
The first step is to tell your midwife or doctor so they can rule out other possible causes of your itching. If OC is suspected, you’ll have some blood tests. These tests will check how your liver is working and measure the level of bile salts in your body. You may itch for several weeks before liver or bile problems show in tests, so these may need to be repeated.
Other conditions, such as viral infections, can cause liver problems. So your doctor may offer you blood tests to rule these out before deciding it’s likely you have OC. There could be another reason why the flow of bile into your gut is blocked. An ultrasound scan can check whether something else, such as gallstones, is contributing to the problem.
Having OC is unlikely to harm you, but the itching can be very uncomfortable. It helps to know that the itching should disappear soon after your baby is born.
Sometimes, OC can affect your blood’s ability to clot. So if you have any bleeding, it would take longer to stop. Your doctor may offer you vitamin K during your pregnancy. Vitamin K plays an important part in making your blood clot.
One of the main concerns with OC is that your baby might be born early. One in 10 women with OC has her baby before 37 weeks. This could happen because you go into premature labour, or because your doctor thinks it is safer for your baby to be born before your pregnancy reaches full-term. If you have OC, your baby is more likely to pass her first poo (meconium) before she is born, which can cause breathing problems for her.
The only cure for OC is giving birth, so the best your doctor can do is help you to cope with the symptoms. Having OC can affect your blood’s ability to clot. You may be offered vitamin K tablets to take daily, although not every woman with OC needs it. Vitamin K may help to reduce the small risk of bleeding heavily after you’ve had your baby.