For medical professionals only
Itchy skin during pregnancy is not necessarily just a skin disease
Ms. Sun, a 25-year-old twin mother who was 7 months pregnant, felt itchy palms and feet some time ago, and her skin was a little yellow. At first she didn't pay attention to it, but recently her belly has begun to itch, and it is better during the day, and it becomes more and more itchy at night. Uneasy, she came to the hospital, and after examination, she was diagnosed with intrahepatic cholestasis during pregnancy, and the doctor told her that there may be a risk of fetal death at any time...
Ms. Shen had severe intrahepatic cholestasis during pregnancy at the time of the first 5 months of pregnancy, considering that the fetus had a serious hypoxia situation, continuing to pregnant may aggravate the pregnant woman's condition, and had no choice but to undergo induction surgery. But in the second pregnancy, she suffered from the disease again, fortunately the treatment was timely, she gave birth to a baby boy prematurely by caesarean section at 32 weeks, and the child is currently developing normally...
Nightmares in the third trimester –
Intrahepatic bileosis during pregnancy
Is intrahepatic cholestasis really that scary during pregnancy?
Intrahepatic cholestasis of pregnancy (ICP) is a complication specific to the middle and third trimesters of pregnancy, which is not serious for pregnant women, but can cause preterm birth, fetal stunting, and even fetal death in perinatal infants.
Why does intrahepatic cholestasis during pregnancy affect the fetus so badly? It turns out that the toxicity of total bile acids accumulates on the placenta, and the passage to supply nutrients and oxygen to the baby is blocked, which will cause intrauterine hypoxia, amniotic fluid pollution and even sudden fetal death in the uterine situation.
What are the manifestations of intrahepatic cholestasis during pregnancy
1. Itching: it is the first symptom of ICP, and more than 70% of patients appear in the third trimester of pregnancy. The degree of itching varies from person to person, with most people feeling lighter during the day and relatively heavier at night. Itching mostly starts from the palms of the hands and feet, and gradually spreads throughout the body, and scratches can appear on the skin of the itchy area.
2. Jaundice: A small number of pregnant mothers can have mild skin yellowing, which generally does not worsen with the increase of gestational age.
3. In addition, there are a small number of pregnant mothers who have nausea, vomiting, loss of appetite, etc., but they are generally not obvious.
Image from the web
Therefore, if there is skin itching during pregnancy, do not simply think that it is only a skin disease and solve it by yourself, you must seek medical treatment in time to eliminate this suspicious bomb.
How to prevent intrahepatic cholestasis during pregnancy
The causes of intrahepatic cholestasis during pregnancy are unknown and may be related to hormonal, genetic, immune, and environmental factors in women.
Intrahepatic cholestasis during pregnancy occurs mostly in the third trimester, multiple pregnancies and previous oral contraceptives, when the patient's estrogen level is higher; the incidence in winter is higher than that in summer; and the incidence rate in the Yangtze River Basin is higher. The disease also has familial aggregation and recurrence. If a mother or sister in the family has intrahepatic cholestasis during pregnancy, the incidence of her offspring also increases; the first pregnancy has a significantly higher chance of developing the disease in the second pregnancy.
How to self-monitor after illness
Intrahepatic cholestasis during pregnancy requires serum bile acid determination (TBA), with a numerical value of ≥ 10umol/L with itching of the skin is the main basis for ICP diagnosis; followed by the measurement of its own liver function, most of the ICP liver function results have mild to moderate elevation; in addition to viral examination and liver ultrasound.
The safety of the intrauterine fetus is related to the severity of the ICP, and the more severe the condition, the higher the risk of sudden intrauterine death of the fetus, and post-morbid surveillance includes:
Regularly review liver function and blood bile acid levels every 1-2 weeks to assess changes in the condition;
Usually pay attention to the changes in fetal movement, fetal movement too much or too little, is not a good sign, need to seek medical treatment in time. After 32 weeks of pregnancy, fetal heart rate monitoring can be measured.
It is important to be vigilant that even if fetal heart monitoring is normal, there is still a possibility that fetal stillbirth may occur intrauterine, and if necessary, the pregnancy needs to be terminated early.
Resources:
Cao Tao. Biochemical characteristics and perinatal outcomes of intrahepatic cholestasis in pregnancy[J].Chinese Journal of Drugs and Clinical Medicine,2019,19(9):1474-1475.
LIU Fang. Causes of intrahepatic cholestasis in pregnancy[J].Health Essentials,2019,(22):29.
Xie Xing,Kong Beihua,Duan Tao. Obstetrics and Gynecology (9th Edition), People's Medical Publishing House, 2018.
This article was first published: Medical Sciences Obstetrics and Gynecology Channel
Author: Liu Wenxin Lin Yuan
Editor-in-Charge: Ichikawa