Cholestasis of Pregnancy; Symptoms, Diagnosis and Treatment

Symptoms of cholestasis in pregnancy

Pregnant women usually experience their symptoms late in the pregnancy when hormones are at their highest. Symptoms differ between women, and there is a difference in symptoms between intra and extrahepatic cholestasis. The most common symptoms include:

• Pruritis: Contrary to popular imagination, jaundice is not the most common symptom of intrahepatic cholestasis, but rather pruritis, which is intense itching, affecting mainly the palms and soles. Itching can be intense and can disturb daily activities of pregnant women. Pruritis results from the accumulation of bile salts in the blood, which then accumulate in different body tissues. It is usually worse at night.
• Easy bruising: Easy bruising is one of the common symptoms in pregnancy. This can be a normal response to some blood changes in pregnancy, but in intrahepatic cholestasis, it results from vitamin K deficiency, which is one of the fat-soluble vitamins.
• Jaundice: Jaundice occurs mainly due to extrahepatic cholestasis rather than intrahepatic one. Jaundice from the obstruction of the flow of bile is usually deep yellow in color.
• Change of the color of stools and urine: Bile flow is what gives stools its color, and the obstruction of its flow results in clay-colored stools. When obstruction is complete or near-complete, bilirubin refluxes back into the blood and is excreted in urine, giving it a dark color, similar to that of liquorice.
• Abdominal pain: Intrahepatic cholestasis is painless, unless it occurred due to liver inflammation (hepatitis). Extrahepatic cholestasis, on the other hand, can be painful and causes attacks of colic at the upper right abdomen due to the presence of gallstones.