Obstetric cholestasis: symptoms, causes and which doctor to see

For obstetric cholestasis you can first see: Obstetrics & Gynecology. If you are not sure, a family doctor (general practitioner) can assess you first and refer you to the right specialist.

Common symptoms: severe itching without a rash; itching on the palms and soles that gets worse at night; dark urine and pale stools; rarely, jaundice. Symptoms vary from person to person; a doctor’s examination is needed for a diagnosis.

The most common causes: pregnancy hormones slowing the release of bile from the liver; genetic tendency; multiple pregnancy; cholestasis in a previous pregnancy. Only a doctor’s examination can determine the exact cause.

Treatment recommended by the doctor reduces itching; bile acids are monitored and the timing of birth can be planned accordingly. It clears within a few weeks after birth.

It is more common in: women in the third trimester; women expecting twins; women who had cholestasis in a previous pregnancy.

It is diagnosed with blood bile acid and liver tests.

It cannot be prevented; early diagnosis is important.

Mild itching from the stretching skin on the abdomen can occur; severe itching on the palms and soles should be checked for cholestasis.

It can raise the risk of preterm birth and other problems; so close monitoring is needed.

If the answer to any of these questions is yes, call 112 without delay: “Has the baby been moving less?” “Is there confusion, fainting or difficulty waking up?” “Is there facial drooping, slurred speech or sudden weakness in an arm or leg?” “Are you struggling to breathe even at rest?”

See a doctor: the same day or within a few days when itching without a rash starts in pregnancy; immediately if the baby’s movements have reduced.