Cholestasis of pregnancy (intrahepatic cholestasis of pregnancy) is a liver disorder that occurs in late pregnancy and results in symptoms of intense itching. Occurs in 1-2 per 1000 pregnancies and tends to occur towards the end of the pregnancy. The condition resolves after delivery with no long term risk for the infant.
Aetiology:
Cause is not fully understood, but it is probably a combination of genetics (ABCB4 gene), hormonal and environmental factors that results in reduced or stopped flow of bile that disrupts liver function.
Risk factors include: history of cholestasis of pregnancy (risk of recurrence can be up to 90%); multiple baby pregnancy; liver disease; gestational diabetes
Clinical Features:
Primary symptom is intense itching (pruritus), especially on the palms of the hands and soles of the feet, but can be anywhere on the body (there is no rash).
Also: urine is darker; jaundice; nausea; loss of appetite; fatigue;
Abnormal liver function tests
Treatment:
Aim of treatment is to reduce symptoms, monitor liver function and reduce the risk of complications.
Ursodeoxycholic acid to decrease bile acid levels
Antihistamines and/or topical measures to relieve itching
Early delivery (usually around 37-38 weeks of gestation)
Complications:
Preterm birth; stillbirth; foetal distress; meconium-stained amniotic fluid; respiratory distress syndrome in the newborn
Relevance to podiatry:
Intense itching (pruritus) of soles of feet; can begin with mild itch on feet before spreading to other parts of the body.
Related Topic:
Pregnancy and the Feet
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