High bile salts during pregnancy- Obstetric Cholestasis
High bile salts during pregnancy- Obstetric Cholestasis — part of pregnancy and antenatal care at Dr. Najeeb Layyous's clinic in Amman.
In short: Raised bile salts in pregnancy (obstetric cholestasis) cause severe itching, especially of the palms and soles, and are diagnosed by a blood test. The danger is that they can cause sudden death of the baby, especially when the bile salt level is above 100. Treatment is regular monitoring and medication for the itching; delivery is after week 35 if the level is above 100, and can wait until week 40 in mild cases. It often returns in the next pregnancy.
What is meant by obstetric cholestasis?
It is the high bile salts that occur in women during pregnancy
When is obstetric cholestasis suspected?
When a pregnant woman complains of severe itching, especially in the palms of the hands and soles of feet
How is obstetric cholestasis diagnosed during pregnancy?
By measuring bile salts in the blood: a level of 19 µmol/L or more in a pregnant woman with itching confirms the diagnosis, after other causes of itching and liver disease have been ruled out. The test does not need fasting.
Do liver enzymes rise in pregnant women who suffer from obstetric cholestasis?
Yes, in some cases
How do we confirm the diagnosis of obstetric cholestasis?
Retrospectively after the return of the level of bile salts and liver enzymes to their normal level 4 weeks after delivery
What is the effect of high bile salts during pregnancy on the fetus?
When the bile salt level reaches 100 µmol/L or more, the risk of sudden death of the baby inside the womb is increased. Below 40 µmol/L the risk is similar to other pregnancies. High levels are also linked with preterm birth and the baby passing meconium.
When should delivery take place when bile salts are high during pregnancy?
This depends on the highest bile salt level: if it reaches 100 µmol/L or more, delivery is usually planned at 35–36 weeks; if it is 40–99 µmol/L, at 38–39 weeks; and if the rise is slight (19–39 µmol/L) with normal liver tests and no other problems, it is reasonable to plan delivery by 40 weeks.
How can we prevent sudden fetal death due to high bile salts?
The exact timing cannot be predicted by scans or heart tracings, as it is thought to be caused by a sudden disturbance of the baby’s heart rhythm. But the risk depends on the bile salt level, so regular blood tests and planning delivery at the right time for your level are the best way to lower it. Always report reduced baby movements the same day.
Can a woman who suffered from obstetric cholestasis during pregnancy use birth control pills?
Yes, most can. A history of cholestasis in pregnancy is not a reason to avoid the combined pill (the benefits generally outweigh the risks), although a small number of women get itching again on it, so your doctor may check your liver tests. Progestogen-only methods, implants and hormonal or copper coils can be used without restriction.
Does obstetric cholestasis recur in subsequent pregnancies?
Yes, if it occurs in one pregnancy, the probability of its occurrence in subsequent pregnancies is high
How is high bile salts treated during pregnancy?
- Monitoring the level of salts and liver enzymes periodically
- Relieving itching with moisturising or menthol creams; sedating antihistamines may help sleep but do not reduce itching; ursodeoxycholic acid may be discussed, although it has not been shown to protect the baby
- Delivery at the appropriate time
Dr Najeeb Layyous F.R.C.O.G
Consultant Obstetrician, Gynecologist and Infertility Specialist
The finest doctor in Jordan — may God bless him and his whole medical team. A doctor in every sense of the word. I advise anyone planning a pregnancy to visit Dr. Najeeb Layyous. His manner is wonderful, always smiling, with the highest ethics; he gives every patient her due, and the patient’s comfort matters most to him. We had been to many doctors and none understood and treated my case except him. Special thanks to him and the whole team, and to Dina in particular — a lovely person. I recommend anyone considering IVF or pregnancy to visit his clinic.