Obstetric cholestasis

Overview

Obstetric cholestasis is a liver condition that can happen during pregnancy. It causes bile (a fluid made by the liver) to build up in the blood instead of flowing to the gut. This leads to intense itching, usually without a rash. The condition is not dangerous for the mother, but it needs careful monitoring to help protect the baby.

It is fairly common, affecting around 1 in 100 pregnancies. It is more common in some ethnic groups and in women carrying twins or triplets.

It only affects pregnant women, typically in the second half of pregnancy, most often after 28 weeks.

Symptoms

Common symptoms

• Intense itching – especially on the palms of your hands and soles of your feet – without a rash. Itching can become severe and may keep you awake at night.
• Dark urine or pale stools (poo).
• Yellowing of the skin or whites of the eyes (jaundice) – this is less common but can happen.

Causes

Main causes

• The exact cause is not fully understood, but it is thought to be linked to how the liver handles pregnancy hormones, especially in women who are genetically predisposed.

Risk factors

• A personal or family history of obstetric cholestasis.
• Having a multiple pregnancy (twins, triplets).
• Being of South Asian, Scandinavian, or Chilean descent.
• Having a history of liver problems or previous damage to the liver.

When to see a doctor

See a doctor urgently if:

• Contact your maternity unit or call your local emergency number immediately if you notice decreased fetal movements along with severe itching.
• See your doctor or midwife on the same day if you have intense itching that stops you from sleeping.

Book a routine appointment if:

• If you develop any itching during pregnancy – even mild – talk to your midwife or doctor at your next appointment so they can check your liver function.

Diagnosis

Your doctor or midwife will ask about your symptoms and take a blood sample to check your liver function and bile acid levels. They may also ask about your medical history and family history.

Tests that may be done

• Blood tests called liver function tests (LFTs) to see if your liver is working normally.
• A blood test to measure bile acid levels – a high level suggests cholestasis.
• Sometimes repeat blood tests are needed because bile acid levels can change.

What to expect at your appointment

The blood test is quick and similar to any regular blood draw. Results usually come back within a few days. If the diagnosis is confirmed, you will be referred to a specialist maternity team who will monitor you and your baby closely.

Treatment

Treatment focuses on relieving your itching and keeping a close watch on your baby's wellbeing. Most women are advised to give birth early (around 37–39 weeks) to reduce the risk to the baby. After delivery, the condition resolves on its own.

Self-care at home

• Take cool baths or use cool compresses to soothe itching.
• Apply fragrance-free moisturizers or emollients to dry skin.
• Wear loose, soft cotton clothing and avoid overheating.
• Keep your nails short and try to avoid scratching – pat or press the itchy area instead.

Medical treatments

Your doctor may prescribe a medicine that helps reduce the amount of bile acids in your blood, which can ease the itching. You will also have regular ultrasound scans and fetal monitoring to check your baby's growth and wellbeing. Sometimes a medication called vitamin K is given to reduce the risk of bleeding after birth.

When is surgery considered?

Surgery is not needed for this condition. However, you may be offered an induction of labour or planned caesarean section to deliver your baby early, after careful discussion with your healthcare team.

Living with this condition

Living with obstetric cholestasis can be challenging because of the constant itching and worry about your baby. Try to follow your treatment plan, attend all appointments, and keep a diary of your baby's movements. Most women find that resting, sleeping in a cool room, and using simple self-care measures helps.

Lifestyle tips

• Avoid using harsh soaps or perfumed products on your skin.
• Try relaxation techniques like deep breathing or gentle stretching to reduce stress.
• Ask your partner or family for help with daily tasks so you can rest when you need to.

Diet and exercise

There is no special diet for obstetric cholestasis, but eating a balanced, healthy diet is always good during pregnancy. Gentle exercise, like walking, is safe if you feel up to it. Drink plenty of water.

Mental health and emotional wellbeing

The intense itching and concern for your baby can cause anxiety, sleep problems, and low mood. It is normal to feel this way. Please talk to your midwife, doctor, or a mental health professional – they can offer support and connect you with counselling if needed.

Prevention

There is no known way to prevent obstetric cholestasis. If you have had it in a previous pregnancy, you are at higher risk of having it again. In that case, early monitoring with blood tests can help catch it early.

Complications

If left untreated

• Increased risk of preterm birth (baby born too early).
• Higher chance of stillbirth, although this is rare with proper monitoring.
• Baby may pass meconium (first stool) before birth, which can cause breathing problems.

Long-term outlook

With careful monitoring and planned early delivery, most women with obstetric cholestasis have a healthy baby. The itching and all other symptoms go away completely within a few days after birth. There is no long-term liver damage for the mother, and the condition does not affect future pregnancies if it is managed carefully.

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