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Ellen Knox, West Midlands Perinatal Insitute, October 2001

Why is it important?

The fetus of the mother with cholestasis is at risk of premature delivery, meconium in the liquor, antepartum stillbirth, intrapartum fetal distress (Reference1,Reference2) and intracranial haemorrhage (Reference2).


Obstetric cholestasis presents with maternal itching, without rash, predominantly on the palms and soles of the feet. However the itching may become generalised and excoriations may be present. It typically occurs in the third trimester but has been recorded as early as the first trimester (Reference3). In a few cases jaundice, pale stools dark urine, steatorrhoea and anorexia may occur but ITCHING IS USUALLY THE ONLY SYMPTOM.

Any woman presenting with itching in pregnancy should have her bile acids and liver function checked. Raised bile acids with or without abnormal liver function (see diagnosis) suggest a diagnosis of cholestasis. If these bloods are normal but the itching persists they should be repeated at regular intervals until they either become abnormal or she delivers.

Our October Perinatal Forum on obstetric cholestasis focused on incidence, pathophysiology, diagnosis and management.


There is worldwide variation. The highest reported rates are in Chile (12-22%) (Reference4), with Scandinavia reporting rates of 2% (Reference5). European rates are 0.2% (Reference6). A retrospective analysis in the South Birmingham area found a prevalence of 0.7% overall (Reference7). There is some evidence that the incidence is increasing but this is likely to represent increased awareness.


1.Reid R, Ivey KJ, Rencoret RH, Storey B. Fetal complications of obstetric cholestasis. Br Med Journal 1976;1:870-2, Abstract

2. Fisk NM, Storey GNB. Fetal outcome in obstetric cholestasis. Br J Obstet Gynaecol 1988; 95:1137-43, Abstract

3. Midgley DY, Khalaf Y, Braude PR, Nelson-Piercy C. Recurrent cholestasis following ovarian hyperstimulation syndrome. Human Reproduction. 1999; 14(9): 2249-2251, Abstract

4. Reyes H, Gonzales MC, Ribalta J. Prevalence of intrahepatic cholestasis of pregnancy in Chile. Ann Intern Med 1978; 88: 487-93, Abstract

5. Berg B, Helm G, Petersohn I et al. Cholestasis of pregnancy. Clinical and laboratory studies. Acta Obstet Gynecol Scand 1986; 65:107-13, Abstract

6. Waine C. Beware of itching during late pregnancy. Practitioner 1995;239:97-100, Abstract

7. Abedin P, Weaver J, Egginton E. Intrahepatic cholestasis of pregnancy: Prevalence and ethnic distribution. Ethnicity and Health. 1999; 4(1-2): 35-37, Abstract


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