Severe itching is the symptom of pregnancy cholestasis. Itching may sound like a harmless ailment, but it can lead to serious health problems in the pregnant woman, premature birth and even death of the unborn baby.
By Brenda Kluijver“It started at 32 weeks of pregnancy with annoying itching on my stomach,” says Hanne van Willigenburg.
“I had never been pregnant before, so I thought: this must be because your skin is stretching. But soon I had a terrible itching all over my body, I really couldn’t stand it anymore. The midwife immediately set off all alarm bells: pregnancy cholestasis. A buildup of bile in the bile ducts. I had to go straight to the hospital.”
Liver damage and fetus at risk
A blood test confirmed what the midwife already thought. “My liver values were very disturbed, I might have had to be induced to protect myself and my baby,” says Van Willigenburg. “I hadn’t thought of that at all, I felt so fit and the pregnancy went smoothly.”
Apart from itching, there are no other severe symptoms in pregnancy cholestasis. Meanwhile, the fetus may be at risk.
It is an image that gynecologist Sam Schoenmakers recognizes. “Apart from itching, which in the beginning often occurs mainly at night and is often on the palms of the hands and soles of the feet, there are no other severe, striking symptoms in pregnancy cholestasis. Stools may be discolored and the urine somewhat darker. But in the meantime, temporary liver damage starts. the pregnant woman and the fetus may be at risk,” he says.
Premature birth due to pregnancy cholestasis
In gestational cholestasis, the accumulation of bile in the mother increases. This increases the amount of bile acid salts in the mother’s bloodstream and therefore also in the unborn child’s bloodstream.
“Because the liver of the unborn child does not yet work sufficiently, the fetus is dependent on the placenta for the removal of these high concentrations. The waste products therefore have to return to the mother’s bloodstream. However, this transport also seems to work less well with pregnancy cholestasis,” explains Schoenmakers.
“These high levels of bile acids in the bloodstream of the unborn child can be harmful to the fetal heart cells. The fetus can develop cardiac arrhythmias that can lead to death. Pregnancy cholestasis can also cause premature birth.”
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Good recovery
In the end, Van Willigenburg’s baby is also delivered too early. “The hospital wanted to give us the choice at first, but insisted on an induction at 35 weeks. The weeks before I was monitored daily, a very uncertain and anxious time. I was always afraid that I would no longer feel my baby”, she tells.
“Fortunately, everything went well with my baby after the premature birth, I had to recover quite a bit myself. My liver and kidneys had suffered a blow from the cholestasis.”
Missed again on next pregnancy
Van Willigenburg again had to deal with the ailment during her second and third pregnancy. “Probably due to genetic factors; they don’t know why I’m so sensitive to this. When the hellish itch started again around 34 weeks, I knew immediately. I was much more aware of the risks to the baby and myself during these pregnancies, but luckily we all got nothing from it,” she says. “Except that all children are born prematurely.”
If you are pregnant and develop a severe itching, it is best to contact your obstetrician or gynaecologist. “Gestational cholestasis usually occurs in the second half of pregnancy. If you receive this diagnosis, liver functions will be monitored and you may be given an ointment or certain medication for the itching. There is also a medicine, Ursochol, which is used to treat the concentration of bile acids. It is not yet clear whether this can also prevent fetal death,” says gynecologist Schoenmakers.
“The international guideline advises to induce birth from 37 weeks in case of severe pregnancy cholestasis. Under no circumstances should a baby be left in place for longer than 40 weeks, because of the higher risk of death of the baby.”
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