It's no secret that during pregnancy , a woman's body experiences very large loads. Moreover, a sharp change in the hormonal background often leads to certain complications. In modern obstetric practice, a disease called pregnant cholestasis is sometimes found. In the absence of timely therapy, such a condition can be dangerous both for a growing child and for the mother's body.
That is why many expectant mothers are interested in questions about what this disease is and why it arises. What are its main symptoms? What treatment can modern medicine offer? Are there effective prevention methods? This information will be interesting to many readers.
What is cholestasis?
Pregnant cholestasis is a disease that is accompanied by dystrophic damage to the liver tissue. A similar violation occurs against the background of an increase in the sensitivity of hepatocytes to sex hormones, the level of which changes significantly during the gestation of the child. The result of this process is a violation of the normal metabolism of cholesterol and bile acids. As a rule, in women with a similar diagnosis, there is a change in bile formation, as well as disruptions in the normal outflow of bile, which, accordingly, affects the work of the whole organism.
Many expectant mothers face a similar diagnosis. But do not be scared immediately, since in most cases you can cope with cholestatic hepatosis (another name for the disease) using conservative medicine without causing any harm to the body of a woman or child.
Disease prevalence
It is immediately worth noting that in some countries this violation is indeed very common. For example, according to statistical studies in the territory of Scandinavia, China, Bolivia and Chile, many expectant mothers suffer from such a disease. But in Sweden there are no more than 40 cases of such a disease per 10 thousand pregnant women.
In Russia, cholestasis during pregnancy is also considered a relatively rare complication - its frequency does not exceed 2%. The only exceptions are the northern regions of the country, where the disease is diagnosed much more often. Based on such data, scientists suggest that the ethnic groups of a woman can be classified as risk groups.
The main causes of the development of the disease
In fact, today it is not completely known why intrahepatic cholestasis of pregnant women develops. There are many theories and research, thanks to which there are three main groups of reasons:
- hypersensitivity of hepatocytes to a group of sex hormones, which is due to genetic characteristics;
- congenital disturbances in the normal synthesis of enzymes that ensure the transport of bile components from hepatocytes to the bile ducts;
- congenital disturbance of the normal synthesis of bile acids associated with a deficiency of certain enzymes. In turn, such a disorder leads to the formation of atypical bile acids.
It is worth noting that in patients with a genetic predisposition or congenital disorders, cholestasis is observed not only during pregnancy, but also with any change in the level of sex hormones (for example, during menstruation, taking oral contraceptives).
The pathogenesis of cholestasis. What happens during an illness?
Pregnant cholestasis is accompanied by three main disorders:
- increased levels of bile elements in the blood;
- a decrease in the amount of secretion in the intestine;
- toxic effects of bile on liver cells and biliary tubules.
Violation of the normal synthesis and outflow of fluid produced by the liver is associated with a sharp increase in the level of progesterone and estrogen. Such a change in the hormonal background slows down the natural movement of bile even during normal pregnancy. And in the presence of birth defects, the risk of dystrophic changes in the filtering organ increases significantly. In addition, an excess of sex hormones affects the pituitary gland, reducing its activity. In turn, a change in the function of this gland affects the processes of liver excretion of bilirubin and cholesterol. This leads to a violation of the mechanisms of formation and secretion of bile.
Disease classification
To date, there are many classification systems for this disorder. For example, depending on the severity of symptoms, mild, moderate and severe forms of the disease are distinguished.
By the nature of the course, cholestasis can be both acute and chronic (in case of a chronic disease, an exacerbation develops during pregnancy). Extrahepatic (develops in the form of obstruction of the bile ducts) and intrahepatic cholestasis (these forms are found in pregnant women) are distinguished depending on the etiology.
Pregnant cholestasis: symptoms and signs
Any deviation from the norm during this period of life requires examination and consultation with a doctor. So what does pregnant cholestasis look like?
Symptoms of the disease, as a rule, begin to bother in the third trimester (28-35 weeks). The main manifestation of the disease is skin itching, and it can have a different degree of severity. Some patients tolerate this disorder easily, while others suffer from constant, excruciating discomfort.
Itching becomes more pronounced at night, which leads to insomnia and, accordingly, constant fatigue, increased irritability, and emotional disorders. Most often, this sensation is localized on the skin of the hands, arms, lower legs, and anterior abdominal wall. Pregnant cholestasis (whose photos are presented in medical directories) leads to excoriation of the skin, as women damage them as a result of constant combing.
Other symptoms of the disease include jaundice. According to statistical studies, a similar disorder is observed in 10-20% of women. As a rule, all signs of the disorder disappear on their own 1-2 weeks after birth. Nevertheless, they can resume against the background of subsequent hormonal disruptions (for example, during a second pregnancy).
Basic diagnostic methods
If there are any deviations, you should immediately consult a doctor. First, a specialist will collect a complete medical history and conduct a physical examination. In some women, slight jaundice and characteristic staining of the sclera of the eyes can be noted. When examining the skin, you may notice redness, abrasions caused by combing the skin.
All these signs indicate that the patient may have pregnant cholestasis. Analysis of the concentration of serum bile acids can confirm the suspicion of the presence of abnormalities in the liver. Various biochemical studies on the content and activity of liver enzymes are also carried out. Ultrasound is also shown, during which an increase in the volume of the gallbladder is noted along with normal liver sizes and uniform echogenicity.
What complications can the disease lead to?
In modern medical practice, they often encounter a problem called pregnant cholestasis. Is this condition dangerous? Of course, yes. Although it all depends on the severity of the pathological process, the time of diagnosis, selected therapy, etc.
Nevertheless, risk always exists. Violation of the formation and excretion of bile affects the metabolic processes. With such a disease, the likelihood of premature birth is high. In addition, the percentage of postpartum hemorrhages among women in labor with a similar diagnosis is also significantly higher, which is associated with impaired vitamin K metabolism and some coagulation factors.
With serious malfunctions in the liver, there is a risk of fetal death, so in some cases, doctors recommend an emergency birth.
Drug therapy during pregnancy
Therapy depends on the severity of the disease and the individual characteristics of the patient. As a rule, plant hepatoprotectors are prescribed first, which protect the liver from damage and do not harm the body. For example, “Hofitol” for pregnant cholestasis gives good results. In addition, the drug "Hepabene" is used in therapy.
In addition to herbal medicines, synthetic hepatoprotectors, in particular Ademethionine, are also used. As antioxidants during pregnancy, tocopherol acetate (vitamin E), as well as ascorbic acid (vitamin C) are prescribed. In addition, it is necessary to take enterosorbents to bind an excess of bile acids in the intestine. An effective and harmless drug is considered "Polyphepan". The course of therapy includes medications that facilitate the outflow of bile and reduce the level of bile acids in the blood. In particular, medicines containing ursodeoxycholic acid, such as Ursosan, are used.
Pregnant cholestasis: non-drug treatment
In addition to drugs, several other therapeutic procedures are used. In particular, pregnant women are often prescribed a course of plasmapheresis and hemosorption. Such procedures are designed to remove excess bilirubin and pruritogens from the bloodstream that cause itching. Such manipulations give a really good result. The full course of treatment, as a rule, consists of four plasmapheresis procedures and one hemosorption.
Proper diet is an important part of therapy.
Of course, after the diagnosis, the doctor will select the most effective and harmless treatment. But an equally important part of therapy is diet. With pregnant cholestasis, you first need to worry about a diet that will reduce the load on the liver.
Patients are advised to reduce the amount of animal fat. In particular, you need to limit the use of fatty meats, butter, dairy products. You should also abandon mayonnaise, sauces and fried foods. Since fats are nevertheless necessary for the normal development of the fetus, their deficiency can be avoided by using substances of plant origin (olive oil, etc.).
Green tea, coffee and choleretic drinks are also contraindicated. Experts recommend temporarily abandoning eggs, olives, legumes, avocados, pickled products, radishes, melons, cauliflower and Brussels sprouts.
However, the diet should be saturated with vitamins and minerals that can be obtained from fresh fruits and vegetables - they should become the basis of dietary nutrition. It is allowed to eat cereals, fish, lean meats. Foods containing high doses of vitamin C, in particular oranges, spinach, herbs, broth from rose hips, etc., will be useful. You need to eat often, but in small portions. It is also important to maintain fluid balance.
Are there effective preventative measures?
Many women are interested in questions about whether pregnancy cholestasis can somehow be prevented. Unfortunately, there are no means that can protect against such violations. Therefore, patients who are at risk are recommended careful monitoring throughout pregnancy.
Even before the onset of the first symptoms, women are prescribed soft hepatoprotectors, antioxidants and choleretics. It is also extremely important to follow the correct diet. And, of course, the expectant mother should regularly undergo examinations and take tests, as this will make it possible to detect abnormalities at an early stage.
How to cope with the symptoms? Patient recommendations
Many women are diagnosed with pregnant cholestasis. Patient reviews indicate that treatment really helps to eliminate disorders and maintain a healthy fetus. Nevertheless, constant itching significantly affects the quality of life.
You can fight this sensation with the help of special compresses. For example, lotions and masks from a decoction of chamomile or oatmeal help eliminate discomfort, as well as positively affect the appearance of the skin and relieve inflammation. Lotions of plain cold water also help, as low temperatures slow down blood flow, reducing itching. Patients also recommend sleeping in ventilated, cool rooms and, of course, carefully follow a diet.