Minor skin problems and itching are relatively common during pregnancy and require little more than reassurance and suitable skin preparations to relieve symptoms.
Occasionally, in less than 1 in 100 pregnancies, the itching may become generalised and severe and be linked to particular changes in the way that the liver deals with its bile salts. The main hormone of pregnancy, oestrogen, may in certain circumstances, cause a considerable delay in the way the liver deals with its breakdown products, namely bile salts, leading to Obstetric Cholestasis (OC). Sometimes, this can happen without symptoms, but generally it is characterised by severe generalised itching on the arms, legs or trunk, most notably, the palms of the hands and soles of the feet. The diagnosis of OC is made by detecting abnormal liver function tests in the blood, together with an elevation of Bile Salts.
The onset of OC is normally in the last third of the pregnancy and tends to be recurrent and sometimes debilitating, disturbing sleep and causing distress.
The significance of OC is that occasionally it is associated with a poor outcome in late pregnancy. The bile salts can accumulate and have a toxic affect on the fetus and very occasionally cause a late stillbirth.
Once the diagnosis is made, careful monitoring of the liver function is introduced and treatment offered according to the symptoms. Sometimes the condition is only temporary and no further action is required. Drugs such as Ursodeoxycholic Acid can often bring down the bile salts and relieve symptoms.
If the condition persists then often the Obstetrician will advice delivery of the baby in the last few weeks of pregnancy. Usually this is after 37 weeks and most commonly by induction of labour. Please see our section on Induction for more details on this.
There are no consequences to the baby after delivery and the liver function of the mother returns to normal almost immediately after delivery.
75% of future pregnancies are likely to be similarly affected. Most women will be advised to avoid taking oestrogen in the future, i.e. not to take the combined pill.