Cholestasis of Pregnancy: Symptoms and Treatment


Cholestasis of pregnant women is a process characterized by increased production of bile by the liver. It occurs because the body of a woman during pregnancy carries a lot of stress, hormonal changes and other processes that affect the work of internal organs. It is because of this and there is a disruption of the liver, which is responsible for the level of bile in the human body.

The most common and the main symptom of the disease is a strong itching of the palms and feet, which tends to worsen at night. Itching is intense to such an extent that a woman can comb the problem areas to the blood. A few weeks after childbirth, all signs of illness disappear.

Pathology develops in a small number of women. And if in time (at the first sign) to see a doctor, then the condition will not significantly deteriorate. If you run it, it will harm both the health of the woman and her unborn baby. The outcome of cholestasis of pregnant women is favorable for a woman, and for a child there is a threat of death in about 15% of cases.

Etiology

Among the main causes of the disease — the environmental conditions in which the woman lives, as well as the region where she lives. The second group of causes is caused by a variety of liver disorders caused by a wide range of ailments, among which:


  • infectious diseases
  • alcoholic liver damage;
  • effects on the liver of toxins or chemicals
  • excessive use of drugs that have a destructive effect on the organ
  • blood poisoning
  • cirrhosis;
  • heart failure;
  • malignant tumors
  • rejection of the organ after its previous transplant;
  • genetic diseases and congenital problems with internal organs
  • sarcoidosis.

The aforementioned etiological factors can provoke an ailment not only in pregnant women, but also in ordinary people. But there are a number of reasons that are typical only for women during pregnancy:


  1. hormonal effects
  2. weakened immunity and the effect on the body of external stimuli
  3. manifestation of cholestasis in a previous pregnancy
  4. unnatural fertilization — IVF
  5. presence of parasites in the female body during pregnancy;
  6. the bearing of two or more fruits by a woman
  7. liver injury (directly during pregnancy).

Species

By localization, the disease is divided into:


  • intrahepatic cholestasis of pregnant women — bile retention occurs within the liver
  • extrahepatic — bile is collected outside the organ.

By the time of manifestation of the symptoms of cholestasis can be:


  1. acute — signs of the disease are expressed unexpectedly
  2. chronic — in which there are periods of remission and a decrease in the severity of the disease.

For skin color changes:


  • icteric — coloring of the skin, mucous eyes and oral cavity in a yellowish color;
  • jaundiced

By the ability to destroy liver cells (cytolysis):


  1. uncyclical;
  2. cytolysis

According to the principles of occurrence:


  • with a reduced amount of bile outflow
  • the delay of some constituents of bile
  • bile flow disorder in the duodenum.

Symptoms

Cholestasis in women during pregnancy is expressed by the following symptoms:


  1. skin irritation, manifested by severe itching. Quite a long time remains the only sign of the disease. The exacerbation occurs at night, during the day the itching is much calming;
  2. appearance on the skin in the back, elbows and chest area of ​​rashes of a yellowish and pale brown hue. In some cases, such neoplasms appear on the eyelids;
  3. hyperpigmentation of the skin;
  4. Stool structure change. With cholestasis, such discharge is discolored, liquid and with a strong unpleasant odor;
  5. urine modification — dark brown
  6. Insufficient amount of vitamins A, E, D in the body, which leads to a decrease in visual acuity, an increased risk of fracture of bones. This sign means that the woman is progressing intrahepatic cholestasis of pregnant women;
  7. weakness of the body
  8. Strong weight loss.

After childbirth, approximately on the second or third day, absolutely all the symptoms of the disease go away.





Complications

Cholestasis during pregnancy entails several consequences for the newborn and the mother. This does not mean that complications appear with every manifestation of the disease, there is only the possibility of their formation.

Possible complications may be:


  • manifestation of signs of the disease during repeated pregnancy;
  • premature birth
  • stones in the gallbladder
  • Insufficiency or cirrhosis of the liver
  • death of a newborn baby
  • intrauterine fetal death

Diagnostics

Diagnosis of cholestasis during pregnancy consists of several stages:


  1. asking the doctor time for the duration of the signs of the disease, possible liver injury before, or during pregnancy
  2. Examination of the patient for the detection of jaundice or cholestasis characteristic of rashes
  3. blood biochemistry
  4. urine tests on the content of substances that can appear in it only during the disease.

In addition, a woman is given a checkup using:


  • Ultrasound;
  • CT;
  • MRI
  • an endoscopic view of the bile ducts
  • conducting a biopsy.

Treatment

First of all, the treatment of cholestasis in women during pregnancy is aimed at eliminating the sources of the disease and reducing the manifestation of symptoms. Prescribe sparing methods of therapy with drugs that serve to protect the liver, but do not harm the body. Most of them are substances of plant origin. This group includes drugs that can lower the level of bile and increase its outflow. To restore the normal content of vitamins, prescribe vitamin complexes and antioxidants. During the treatment, procedures are applied that eliminate the «causative agents» of the itching in the blood, such as plasmapheresis and hemosorption.

An important role in the treatment of cholestasis is given to a special diet, which is the most innocuous therapy.

The diet limits use:


  1. fatty meat
  2. Butter;
  3. fermented milk products
  4. Legumes
  5. fried foods
  6. mayonnaise
  7. spicy sauces and spices
  8. Green tea
  9. Coffee;
  10. eggs (one per day allowed);
  11. raznosolov;
  12. vegetables — cabbage (except white cabbage) and radish
  13. fruit — melon, avocado
  14. alcohol;
  15. fatty broths
  16. Meat products
  17. Ice cream.

But nevertheless, the diet of a woman during pregnancy should be enriched with vitamins, calcium and nutrients, otherwise treatment is considered inferior. During a diet, you can not limit yourself to absorption:


  • Freshly squeezed juices
  • Fresh fruit and vegetables, except for forbidden;
  • vegetable broths
  • porridge
  • boiled chicken;
  • jam and honey
  • loose black tea
  • bread from bran.

Prevention

Prevention of cholestasis is:


  1. managing a healthy lifestyle not only during pregnancy, but also after the birth of the baby;
  2. timely treatment of diseases and elimination of risk factors that may lead to such a disease
  3. observing a not strict but effective diet
  4. A regular checkup for doctors.