What causes recurrent itchiness in a cholestasis patient?

Question

Hello doctor,

I was diagnosed with obstetric cholestasis two months back due to symptoms of itchy palms and feet. My LFT's and bile acids where raised. I was put on Ursodeoxycholic acid 500 mg twice daily and pregnancy vitamins. My symptoms disappeared within a week. I am closely monitored, weekly blood, growth scans, etc. But after 34 weeks, itchiness has come back. Baby is active; blood remains stable. I am not sure what to do. Should I increase my medication? Why has the itching suddenly come back after nearly three months of taking the medication? I would be grateful for your opinion.

Kindly give your opinion.

Answer 1

Hi,

Welcome to icliniq.com.

You are right. You have symptoms and signs of OC (obstetric cholestasis) that shows itching on palms and soles in the absence of rash with abnormal LFT and bile acid and resolves after birth. Obstetric cholestasis has increased the risk of preterm birth especially iatrogenic; fetal distress causes passage of meconium that leads to cesarean section, post delivery bleeding. Due to risk mentioned above, the fetus should be monitored regularly and frequently along with mother's blood investigations to know the level of liver enzymes and bile acid.

As you are feeling increased symptoms instead of taking medications regularly, I wanted to know have you been checked for other liver-related diseases at the start of pregnancy? And when you had last CTG (cardiotocography), electronic fetal monitoring for baby. For safer side, you should have one CTG for baby's well being and repeat blood investigations for the most recent status of disease as symptoms reappear and now already you have crossed 34 weeks. Vitamin K specifically you should have for this diagnosis and baby also just after birth. Dexamethasone can be added to prescription 10 mg orally for seven days, then to stop for three days. The Ursodeoxycholic acid dose could be increased after laboratory reports. So, my advice is better to have one CTG in an emergency due to the fetal risk of still birth in OC and to repeat blood investigations for necessary changes in dose or addition of medicines I have mentioned above. I hope you understand my point. You should have laboratory tests and CTG immediately to plan further. Keep a strict check on baby's movements.

I hope this helps.

Take care.