Obstetric Cholestasis - Symptoms

What are the symptoms of obstetric cholestasis?

The most common symptom is a really bad itch. You don't get a skin rash but you may get marks on your skin from where you have scratched. The itch can be all over, although it is often particularly bad on your hands and feet. It is often worst at night. Usually itch is the only symptom. The itch tends to get worse until you have your baby. The itch can become so severe that it starts to affect your sleep, your concentration and your mood. It can be really distressing.

Typically, symptoms start after 24 weeks of your pregnancy, when the hormone levels are at their highest. Sometimes it can develop earlier in pregnancy.

Note: mild itching from time to time is normal in pregnancy. However, if you develop a constant itch that gets worse, tell your doctor or midwife. A blood test can confirm if you have obstetric cholestasis.

Other less common symptoms include:

  • Tiredness.
  • Going off your food and feeling sick.
  • Mild jaundice: you may go yellow and your urine may get very dark in colour and your stools go pale. This is uncommon and due to an increased level of bilirubin (part of bile) leaking from the bile ducts into the bloodstream. See separate leaflet called Jaundice for more details.

A rash is not a symptom of cholestatic jaundice. If you develop a rash you should seek medical advice.

Who gets obstetric cholestasis?

Obstetric cholestasis occurs in less than 1 in 100 pregnancies in the UK. It is more common if you are carrying twins, triplets, or more. It is also more common if you are of South Asian origin, when it affects about 1 in 67 pregnancies. In certain parts of the world, especially in Chile and Bolivia, up to 1 in 20 or more pregnant women develop this condition.

Mothers, daughters and sisters of women who have had obstetric cholestasis have a higher than average risk of also being affected when pregnant. If you have obstetric cholestasis in one pregnancy, you have a high chance that it will happen again in future pregnancies.

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  • 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.
  • Lee NM, Brady CW; Liver disease in pregnancy. World J Gastroenterol. 2009 Feb 28 15(8):897-906.
  • Williamson C, Geenes V; Intrahepatic cholestasis of pregnancy. Obstet Gynecol. 2014 Jul 124(1):120-33. doi: 10.1097/AOG.0000000000000346.
  • 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.
Dr Jacqueline Payne
Peer Reviewer:
Miss Shalini Patni
Document ID:
4401 (v43)
Last Checked:
01 July 2017
Next Review:
30 June 2020

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Patient Platform Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.