Causes of holestaza
In the last trimester of pregnancy concentrations of sex hormones reach their maximum values. In some women, the liver cells can not cope with the physiological excess estrogens, increases the level of free bile acids in plasma, and they cause itching.
The risk of cholestasis in pregnant women
Bile acids circulating in large quantity in the blood is very toxic to the placenta. They affect the blood vessels of the body. As a result, the placenta becomes unable to provide the needs of the child oxygen and nutrients. There is an acute asphyxia and death.
Typical and the only symptom of the disease – itchy skin during pregnancy. He appears only in the last trimestre. First get itchy feet, hands. Condition worsens in the evening and at night. With the growth of concentration of bile acids itching all over the body (legs, abdomen), itching becomes very intense and painful. Appear scratching of the skin.
It is important to note that the color of the skin remains normal, no jaundice. Blood tests, which are used to assign expectant mothers as screening (total bilirubin, AST, ALT, alkaline phosphatase, cholesterol) may be within normal limits. Sometimes slightly increased AST and ALT.
At the beginning of the disease it is impossible to identify the signs of suffering of the fetus. Data CTG ultrasound and the baby remain normal.
Sometimes it happens that the most severe itching suddenly disappears. Most often this indicates that the crash occurred and the child died. In this case, you need to urgently contact the hospital. But it is best not to go to the extreme condition.
Crucial in the diagnosis belongs to determine the concentration of free bile acids in plasma. Unfortunately, this analysis is not included in the screening done only in some commercial laboratories.
Normal bile acid concentrationshould not exceed the value of 5.7 µmol/l in pregnant women allowed increasing the level to 7 mmol/l. Itching in pregnant women appears when the concentration of bile acids , more than 11 µmol/l. The value of 40 mmol/lis clinically seen painful intolerable itching of the skin. And it is this value (40 µmol/l and above) is extremely dangerous for the child and is an indication for urgent delivery. Therefore, even if the doctor has not appointed a blood test to free bile acids in the last trimester it is worth it in any case to make, and if you start to scratch the skin, the first analysis that you need to do is to determine bile acids in blood.
Cholestasis of pregnant treatment
The only drug that is able to help the woman – "Ursosan" (ursodeoxycholic acid). The main active ingredient of the medicine non – toxic water-soluble acid that is able to bind and neutralize toxic bile acids. The drug much easier as the mother and improves the prognosis for the child. Medicine is prescribed only if the concentration of bile acids less than 40 µmol/l, at a dose of 10-15 mg/kg.
If a woman has increased levels of AST and ALT is also well worth taking "she". Absolutely can not take the medications from the group of essential phospholipids, e.g. "Essentiale", they can worsen the condition. It is also recommended to eliminate all of the additional drugs such as vitamins in order to unload the liver.
And of course, if you have cholestasis, it must be under the supervision of the obstetrics ward. Of the therapeutic measures that can be performed in hospital, usually plasmapheresis and hemosorbtion.
The main tactics of the doctor – as much as possible to prolong pregnancy. Delivery before 37 weeks is indicated for treatment failure and high risk for the baby.