Pregnancy, cholestasis or itching?

Pregnancy, cholestasis or itching?
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Cholestasis or itching?

It can happen that severe itching occurs during pregnancy. Often this is a simple annoyance that affects many women, but, at times, the itch could also be the sign of a more serious ailment, which is called cholestasis gravidarum.





Cholestasis or simple itching? Let's try to understand exactly when it comes only to pruritus and when instead of cholestasis of pregnancy.

In this article

Itching, a common complaint in pregnancy

Itching can be a common ailment during pregnancy. In most cases it appears in thelast quarter, when the belly increases in volume, the skin stretches and tends to be drier. It is of interest, in fact, above all abdomen, hips and thighs. 



In general, itching in pregnancy is a physiological condition and does not cause risks for either the mother or the baby. It affects at least 20% of pregnant women (one in five). Despite this, according to the doctor Valentina , gynecologist and phytotherapist, it is always worthwhile anyway talk to your doctor, even if it is a mild symptom, to be sure it is not associated with other diseases.

If the doctor determines that it is only physiological itching, it is possible that he prescribes it antihistamines and cortisone creams to relieve symptoms. "Oral steroids may be needed only in special cases," says the doctor. Read also: Itching in pregnancy: how to relieve it, when to worry

Itching in pregnancy, when it is associated with other diseases

When itching is the sign of other diseases, it usually affects not only the abdomen, but also other parts of the body or is accompanied by rashes. If the itch is not physiological, it can be caused by other diseases, including: 
  1. Atopic eruptions of pregnancy. The term refers to forms of itchy eczema which usually occur in the first or second trimester of pregnancy, in women who have a personal history of atopic dermatitis, even if they may no longer suffer from it since childhood. It does not involve risks for pregnancy, mother and baby.
  2. PUPPP. It is a fairly rare urticaria that occurs with the appearance of itchy plaques and papules typically on the stomach, butt and thighs. It generally affects the first pregnancy, but not the subsequent ones and it is not dangerous for the mother or for the unborn child.
  3. Gestational pemphigoid. Disease very rare (one case every 10 thousand pregnancies) with an auto-immune basis. It begins with intense itching followed by the appearance of characteristic skin lesions (plaques, papules), which eventually become blisters. It may be associated with risks to the baby, particularly of preterm labor and low birth weight. Since the autoantibodies produced by the mother pass through the placenta, the newborn can also be affected, but in a mild and temporary way.
  4. Cholestasis pregnant. In the next paragraph we will find out exactly what it is.
Read also: Spots on the face in pregnancy

Cholestasis gravidarum, what it is and how it manifests itself

La cholestasis of pregnancy - or intrahepatic cholestasis of pregnancy - is a liver disease that occurs only in pregnancy. This disease has itching as its main symptom and, if neglected, it can provoke complications even serious to the baby.



According to the gynecologist Flavio Del Savio, former director of the maternal-infant department of the Ospedali Riuniti of Ancona, pregnancy cholestasis involves a accumulation of bile salts in the liver and in most cases occurs at the end of the second or early third trimester of pregnancy (although it can also appear earlier).

Cholestasis affects approximately1-2% of pregnant women, even if its incidence varies greatly from country to country.

Il symptom typical is an itchy skin, which begins on the soles of the feet and hands, and then generalizes. The manifestations of itching occur mainly during the notte and they can be intense, so much so that they affect the quality of life of the woman.

Confirmation of the diagnosis comes from the specific outcome blood tests, such as the dosage of bile acids, bilirubin and transaminases, if they testify to the concentration of bile in the liver.

Read also: Pregnancy cholestasis, symptoms and treatments

Pregnancy cholestasis, potential risks

Pregnancy cholestasis, risks for the mother 

In general, there are no major risks for the mother. However, there may be a greater tendency to deathly post-partum caused by disease-associated malabsorption of vitamin K (vitamin K is a substance involved in blood clotting mechanisms). This drawback can however be easily overcome by providing the mother vitamin K supplements in the last weeks of pregnancy.

For the rest, after the birth everything passes and even the itching finally stops; for the first three months, however, i biliary values ​​and jaundice, to verify that everything is back to normal.

Pregnancy cholestasis, risks for the baby 

According to recent research, if neglected, cholestasis can cause serious damage to the child. This is because the accumulation of bile acids in the blood can reduce the synthesis of pulmonary surfactant, a substance produced by the fetus that induces lung maturity and allows the baby to have respiratory autonomy at the time of birth. In addition, they can result in the entry of meconium in the amniotic fluid which, when inhaled, can cause asphyxiation immediately after birth.

International guidelines advise against postponing childbirth beyond 37 settimane, when the greatest risks could arise.

Read also: The meconium of the newborn

Cholestasis gravidarum, the treatments

Pregnancy cholestasis is treated with l'ursodesossicolic acid. It is a drug that helps relieve itching, improves fetal parameters and gives the least side effects.

Certainly cholestasis can be kept under control with pharmacological therapy and with frequent checksuntil the time when doctors assess that it is necessary to induce childbirth.

Read also: Itching or cholestasis: what's the difference

Sources: 

information material on the Emedicine / Medscape website

articolo Pruritus in Pregnancy (su Canadian Family Physician)

msdmanuals

TAG:
  • pregnancy cholestasis
  • intraepatic cholestasis
  • wellness in pregnancy
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