Cholestasis of Pregnancy; Symptoms, Diagnosis and Treatment

Diagnosing cholestasis in pregnancy

Pregnant women should have regular follow-ups during their pregnancies to assess the status of her body and her baby. During such routine follow-ups, they should report any new or troublesome symptoms that they have. If you show any signs or have any symptoms of cholestasis, your doctor will ask you further questions to assess your condition and then will perform a general clinical examination. This includes an abdominal examination and examination of your baby. They will then order a number of investigations to confirm your condition including lab tests like:

  • Serum bilirubin: Bilirubin can be measured in the blood, and it rises in cases of cholestasis whether intra or extrahepatic. Its level can give a general impression on the severity of the condition. It is divided into direct and indirect bilirubin, with the direct subtype rising more prominently in cholestasis.
  • GGT: GGT is an enzyme that rises in case of injury to the biliary tree, and can rise both in intra and extrahepatic cholestasis.
  • Serum bile acid levels: Serum bile acid levels both diagnose the condition, and help in the follow-up of its progress, which is of great importance in assessing its severity.
  • Liver function tests: Liver function tests include liver enzymes, which rise in liver inflammation, and can help exclude other causes of jaundice related mainly to the liver.
  • Coagulation profile: Coagulation profile can be considered as one of the liver function tests. It includes PT, PTT, and INR. It can detect deficiency of vitamin K.
  • Other routine tests: Other routine tests include a complete blood count and kidney function tests.

Imaging studies are also of importance in this condition including:

  • Ultrasound of the abdomen: Ultrasound of the abdomen can detect the presence of a gallstone in the gallbladder as well as the dilatation of the branches of the biliary tree within the liver, which is a sign of extrahepatic cholestasis. It can also assess the general condition of the liver and the presence of cirrhosis.
  • MRCP: Magnetic resonance cholangiopancreatography is one of the imaging studies used to assess the presence of stones in the common bile duct and the small bile channels in the liver.
  • ERCP: Endoscopic retrograde cholangiopancreatography is another option to detect and assess the biliary tract using an endoscope and contrast, then an Xray is done to detect any problem present.

Usually, the above tests are enough to detect cholestasis and to detect whether it is intra or extrahepatic. Liver biopsy is another option, but it rarely done since it is aggressive and can cause additional problems in pregnancy. It involves taking a small sample of the liver under anesthesia and then examining it under the microscope. It is used in a few cases where the diagnosis is unclear.