What is Obstetric Cholestasis? What Are the Symptoms?

last updated on: 03.06.2025 | Medical review by:

Mayara Belli

Nutritionist

One of the issues that can hinder the smooth progress of pregnancy is obstetric cholestasis, also known among doctors as intrahepatic cholestasis¹. This disease can affect the mother intensely due to the symptoms it causes, but in some cases may also impact the baby’s growth and lead to more serious problems.

Obstetric cholestasis is a disease that affects the mother’s liver. This organ produces a secretion called bile², which acts like an acid during intestinal digestion. Obstetric cholestasis happens when the bile isn’t fully absorbed by the body because it is not completely directed to the intestine, so the excess enters the bloodstream.

The symptoms of obstetric cholestasis can vary, but the most common is intense itching for the pregnant woman. It can affect the whole body, but especially the extremities like hands and feet. Itching intensifies at night and can cause problems sleeping. Itching mainly affects the palms of the hands and soles of the feet. After the initial symptoms, it spreads throughout the body if untreated.

How is Obstetric Cholestasis Diagnosed?

Besides the symptoms, some tests will be done to be 100% certain that it is cholestasis. A blood test and even an ultrasound can diagnose obstetric cholestasis. These tests are essential to determine why the flow of bile to the intestine is being blocked. If there are gallstones, the doctor will assess the risks of removing them during pregnancy. To treat the symptoms of obstetric cholestasis, the doctor will prescribe vitamins that help the body absorb bile, such as vitamin K. This vitamin also helps reduce the chances of hemorrhage due to excess bile in the blood for both the mother and baby.

In fact, the baby can be affected by the bile that circulates through the woman’s body. The risk of death still in the womb is 15% higher compared to diseases like preeclampsia, for example. That’s why getting an early diagnosis as soon as symptoms appear is very important. The biggest question specialists have is why the risk of fetal death is higher. It is thought that bile may contribute to placental failure and may also cause premature maturation resulting in calcifications³. Since most cases of obstetric cholestasis occur at the end of the pregnancy, the doctor may choose to induce labor to reduce or even eliminate the chances of an unexpected event.

Keep in mind that not all itching in pregnancy is obstetric cholestasis. This is a rare disease that affects pregnant women. Most cases of itching are mild and are due to stretching skin from a growing belly and increased blood circulation. But it is advisable if you feel any itching, or unusual pruritus, to speak with your obstetrician to start an investigation.

To help relieve the symptoms of obstetric cholestasis, the pregnant woman can wear light clothing, use soothing skin creams with calendula, calamine lotions, and take warm showers instead of hot or immersion baths.

Photo: lemonteiross

References:

1Tan, L. K. (2003). Obstetric cholestasis: current opinions and management. Annals of the Academy of Medicine, Singapore, 32(3), 294-298.
2Strazzabosco, M., & Fabris, L. (2008). Functional anatomy of normal bile ducts. The Anatomical Record: Advances in Integrative Anatomy and Evolutionary Biology: Advances in Integrative Anatomy and Evolutionary Biology, 291(6), 653-660.
3Milkiewicz, P., Elias, E., Williamson, C., & Weaver, J. (2002). Obstetric cholestasis: May have serious consequences for the fetus, and needs to be taken seriously. BMJ, 324(7330), 123-124.

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