clinical features

Last edited 10/2020 and last reviewed 11/2020

Clinical features

Pruritus in pregnancy is common, affecting 23% of pregnancies, of which a small proportion will have obstetric cholestasis (1)

• pruritus of obstetric cholestasis is typically worse at night, is often widespread and may involve the palms of the hands and/or the soles of the feet
• women present with pruritus without rash, characteristically after 30 weeks' gestation
• pruritus often worsens as the pregnancy progresses
- pruritus that involves the palms and soles of the feet is particularly suggestive
• steatorrhoea and dark urine may occur
• jaundice is a rare symptom (2)
• increased rates of postpartum haemorrhage have been postulated to be due to vitamin K deficiency
• gallstones may be present more often in affected women
• women with hepatitis C infection have a higher incidence of intrahepatic cholestasis of pregnancy (2)
• preeclampsia and gestational diabetes are seen more commonly in women with intrahepatic cholestasis of pregnancy (2)

Reference:

1. Royal College of Obstetricians and Gynaecologists (April 2011). Guideline No. 43 - Obstetric cholestasis.
2. Walker KF et al. Pharmacological interventions for treating intrahepatic cholestasis of pregnancy. Cochrane Database of Systematic Reviews 2020, Issue 7. Art. No.: CD000493. DOI: 10.1002/14651858.CD000493.pub3.
3. BMJ 1994;309:1243-1244
4. BMJ. 2002 Jan 19;324(7330):123-4