Obstetric cholestasis – what you need to know

Could you have OC in your pregnancy? Here's what to look out for and what to do if you have it

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Obstetric cholestasis (OC), sometimes also called intrahepatic cholestasis of pregnancy (ICP) , is a liver disorder that occurs during pregnancy. The flow of bile from the liver is reduced so there are more bile salts in the blood.

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These are quite toxic, and scientists believe that they may affect the baby’s heart and also the placenta. It typically starts at around 28 weeks, but it can be earlier.

Who is at risk of OC? 
Around 5,000 women in the UK develop the condition every year. A definitive cause is not known but it can run in families.

They also think that hormones are involved, as once the mother has the baby the bile starts to flow properly again.

What symptoms should I look out for? 
The first noticeable symptom is itching without a rash. It typically starts on the hands and feet but can occur anywhere on the body.

This is not always just mild irritation – sometimes it can be so bad that you can’t stop yourself from scratching it.

Women often report that it’s more noticeable at night, making it difficult to sleep. Other symptoms may include pale stools, dark urine, and jaundice.

“When the itching starts, it can be hard to sleep, but you don’t get a rash like you would with a normal skin condition,” says Henry Annan, consultant obstetrician and gynaecologist from the Royal College of Obstetricians and Gynaecologists.

How is OC diagnosed? 
The condition will be diagnosed by a blood test and you may be given drugs to help improve liver function,” says Henry. “Your baby will be delivered at 38 weeks. Within a week or so of giving birth, the symptoms clear: there are no long-term problems with the liver.

How serious is OC? 
Research has shown that there is an increased risk of spontaneous premature labour, foetal distress and, in very severe cases, stillbirth.

This all sounds scary, but the good news is that doctors also believe that, if your pregnancy is carefully managed, you have regular blood tests and take medication to try and improve your bile acid levels, and that you have your baby earlier (usually by 38 weeks), your baby is much better protected.

What can I do to soothe it?
‘To cope with the itching, stay in cool temperatures and don’t use too many bedclothes – that will make you hot and the itching worse,” says Henry. “Calamine lotion can sometimes help to soothe the itching.

Where can I go for help for OC? 
If you experience itching, aside from the stretching skin on your bump, let your midwife, GP or obstetrician know.

They will decide if you need blood tests to find the cause. OC Support UK (ocsupport.co.uk) and British Liver Trust (britishlivertrust.org.uk) offer support.

What about after the birth? 
Once you have your baby there are no extra tests needed for him or her. You’ll have liver function and bile acid tests after about 6-12 weeks to make sure everything is back to normal.

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Can I have more babies? 
Although OC needs managing, there is no reason why not. You are quite likely to get it again, though – research shows a risk it will reoccur of up to 90%.

Mums share their OC stories
“I had obstetric cholestasis in both my pregnancies,” Sally, 31, tells MadeForMums.

“During my second pregnancy, I started to itch at 32 weeks. I was waiting for it, as I had been told that it was likely to reoccur.

“I made a midwife appointment, had a blood test and was told they’d let me know the result, but I had to chase it up myself.

“The doctor phoned me back and said I had to go straight to hospital as I had OC. I panicked, even though I’d had it before, as it can be so dangerous for the baby.

“I was put on medication, which quickly helped, and from then on I had to go to the hospital several times a week for blood tests and to monitor the baby’s heartbeat. I ended up having an elective caesarean at 38 weeks and my baby was fine, thankfully.”

“I had OC when pregnant with my twins,” says Jo. “I developed it at about 31 weeks, and I had an emergency c-section at 35 weeks, so thankfully I didn’t have to suffer to long with it.

“The itchiness was driving me crazy by the time I had my girls, and I found it difficult to sleep, it was worst on my bump which was one big red mess!! But I was the same, baths and showers and nakedness seemed to soothe it all.”

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