How is obstetric cholestasis diagnosed?
The diagnosis of obstetric cholestasis is suspected if, while pregnant, you develop an itch without any skin rash to explain the itch. A blood test can detect the level of bile acids and liver enzymes in the blood which will be higher than normal. Other blood tests may be taken to measure other liver functions and to rule out other causes of liver problems such as viral hepatitis. In some cases the itch develops a week or more before the blood test becomes abnormal. Therefore, if the first blood test is normal then another may be done a week or so later if the itch continues.
Sometimes, if your doctor is worried that there might be another reason for your symptoms, you may also need to have an ultrasound scan of your liver and extra scans of your baby.
The diagnosis is confirmed if you have:
- Itch that is not due to any other known cause (such as a skin disorder).
- High levels of liver enzymes and/or bile salts in your blood that cannot be explained by any other liver disease.
Once diagnosed, you will usually need to have a blood test done every week or two until your baby is born. This is done to keep an eye on the levels of liver enzymes and/or bile salts in your blood - experts think that if there is going to be a problem, it is more likely in women with the highest levels.
Both the itch and the high levels of liver enzymes and bile salts will go away soon after your baby is born. A blood test is usually done at least 10 days after your baby is born to confirm that everything is back to normal. This sometimes helps to confirm that the diagnosis was obstetric cholestasis, if there had been any doubt. Sometimes the test is done again at around six weeks after the birth, shortly before your postnatal check, if the levels hadn't completely gone back to normal with the first test.
Did you find this information useful?
- Obstetric Cholestasis; Royal College of Obstetricians and Gynaecologists (May 2011)
- Gurung V, Middleton P, Milan SJ, et al; Interventions for treating cholestasis in pregnancy. Cochrane Database Syst Rev. 2013 Jun 24 6:CD000493. doi: 10.1002/14651858.CD000493.pub2.
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- Kong X, Kong Y, Zhang F, et al; Evaluating the effectiveness and safety of ursodeoxycholic acid in treatment of intrahepatic cholestasis of pregnancy: A meta-analysis (a prisma-compliant study). Medicine (Baltimore). 2016 Oct 95(40):e4949.
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