What is obstetric cholestasis (OC)?
OC is a liver disorder that occurs during pregnancy. The flow of bile from the liver is reduced so there are more bile salts in the blood. These are quite toxic, and scientists believe that they may affect the baby's heart and also the placenta. It typically starts at around 28 weeks, but it can be earlier.
Who is at risk?
Around 5,000 women in the UK develop the condition every year. A definitive cause is not known but it can run in families. They also think that hormones are involved, as once the mother has the baby the bile starts to flow properly again.
What should I look out for?
The first noticeable symptom is itching without a rash. It typically starts on the hands and feet but can occur anywhere on the body. It may be mild or severe. Women often report that it's more noticeable at night. making it difficult to sleep. Other symptoms may include pale stools, dark urine, and jaundice.
How serious is it?
Research has shown that there is an increased risk of spontaneous premature labour, foetal distress and, in very severe cases, stillbirth. This all sounds scary, but the good news is that doctors also believe that, if your pregnancy is carefully managed, you have regular blood tests and take medication to try and improve your bile acid levels, and that you have your baby earlier (usually by 38 weeks), your baby is much better protected.
Where can I go for help?
If you experience itching, aside from the stretching skin on your bump, let your midwife, GP or obstetrician know. They will decide if you need blood tests to find the cause. OC Support UK (ocsupport.co.uk) amd British Liver Trust (britishlivertrust.org.uk) offer support.
What about after the birth?
Once you have your baby there are no extra tests needed for him or her. You'll have liver function and bile acid tests after about 6-12 weeks to make sure everything is back to normal.
Can I have more babies?
Although OC needs managing, there is no reason why not. You are quite likely to get it again, though - research shows a reacurrence risk of up to 90%.