Cholestasis during pregnancy treatment. Possible consequences, measures to prevent cholestasis. Why does it occur in pregnant women

During pregnancy, a woman's body undergoes mass various changes including at the hormonal level. In the third trimester, pregnant women often experience such a phenomenon as cholestasis. The causes of the problem are associated with heredity, medication, toxic liver damage.

What is cholestasis of pregnancy?

Cholestasis is a disease of the liver, which is characterized by the cessation or decrease in the production of bile, the flow of a substance into the duodenum. In pregnant women, cholestasis can be not only the result of changes in hormonal background, pathology often develops with urolithiasis, inflammatory processes, malignant and benign neoplasms.

There are two types of cholestasis: intrahepatic, extrahepatic. With intrahepatic cholestasis of pregnant women in the liver, pathological changes are observed at the cellular level. It is associated with hepatitis, cirrhosis, reactions to certain medications, hormonal changes.

It is assumed that an increase in the size of the uterus plays a large role, resulting in changes in the position of organs in abdominal cavity. At a later date:

1. intestinal loops are displaced;
2. there is pressure on the parenchyma;
3. the outflow of bile through the intrahepatic ducts is disturbed.

Cholestasis develops during pregnancy that occurred during artificial insemination, toxic and alcoholic lesions of the organ, unsuccessful pregnancies in history, which ended in intrauterine fetal death or miscarriage.

Depending on the signs, doctors distinguish several forms of the disease: functional, clinical, morphological.

With functional cholestasis, there is a decrease in the level of bile acids, bile flow. Morphological cholestasis is characterized by the accumulation of bile in hepatocytes, bile ducts, clinical form The disease is manifested by the retention of bile components in the bloodstream.

Extrahepatic cholestasis is a blockage of the bile ducts outside the liver. During pregnancy, the liver often weakens, the development of the disease is affected hypersensitivity to female sex hormones. By the end of pregnancy, the estrogen level increases several times.

Symptoms of liver dysfunction

Stagnation of bile during pregnancy is a phenomenon that occurs in a woman starting from the 28th week of the term. You can suspect a problem in yourself by signs such as dryness. skin, severe itching of the palms and feet, sleep disturbances, bitterness in oral cavity. The woman suffers from increased fatigue, she feels unwell, mood swings are observed.

Some patients develop mild forms of jaundice, urine becomes dark color, feces, on the contrary, becomes light. Characteristic itching and hyperemia can mislead the doctor, the pathology is confused with allergic diseases of the skin.

Failures in the flow of bile become a prerequisite for a violation of the digestive process. With bile deficiency, normal lipid digestion is impossible. As a result, a woman changes taste preferences, for example, there is an aversion to fatty foods. When they are used, dyspeptic disorders of varying severity occur:

• diarrhea;
• pain syndrome in the abdominal cavity;
• discomfort under the right rib.

Since changes in taste and digestive disorders are often considered normal during childbearing, they are often overlooked.

With a long course of cholestasis, bile damages the liver parenchyma, which causes mild drawing pains in the right side. Feelings can be significantly intensified after eating, physical activity. In this case, a blood test will show specific damage to the filtering organ.

Often, the symptoms completely disappear a few days after childbirth, when the work of the gallbladder and liver returns to normal. However, in subsequent pregnancies, the problem may recur with renewed vigor.

Diagnosis of cholestasis in pregnant women

During the first appointment, the doctor listens to the woman's complaints, finds out the presence of predisposing factors, concomitant diseases, including chronic ones. During a visual examination, the doctor examines the skin for changes in color, scratching, palpates the liver.

If cholestasis is suspected, the patient is prescribed a number of laboratory, instrumental research. First of all, surrender general analysis blood, allowing you to see the inflammatory process and its intensity. It is also necessary biochemical research, urine test for bilirubin level.

A blood test necessarily includes liver tests, an analysis of bile acids. With an increase in bilirubin in the bloodstream, they speak of stagnation of bile, damage to hepatocytes. Take into account the quantity:

1. alkaline phosphatase;
2. enzymes AST, ALT.

In addition to laboratory tests, instrumental methods are recommended to clarify the alleged diagnosis - ultrasonography(ultrasound), magnetic resonance therapy (MRI).

When conducting an ultrasound of the organ, the degree of its damage, the presence of pathological changes, stones, cystic neoplasms that prevent the normal outflow of bile. In doubtful cases, resort to MRI or the study of the bile ducts using endoscopic cholangiography.

The problem is that the diagnosis of cholestasis during pregnancy is difficult. It is possible to determine the violation only a few weeks after the onset of the first symptoms.

Pathology treatment methods

After a complete diagnosis of the body, the woman is prescribed a course drug treatment. The choice of treatment regimen is determined by the severity of cholestasis, the characteristics of the woman's body.

Preparations

According to physicians, best means to eliminate cholestasis are medicines, which contain ursodeoxycholic acid. The drugs help to improve the microcirculation of bile acids, stabilize hepatocytes.

To prevent bleeding after childbirth, doctors prescribe a woman to take a course of vitamins A, E, D, K. Previously, gynecologists recommended antihistamines to patients, for this moment scientists have proven that similar cases they do not bring positive results.

To eliminate the violation, tablets are prescribed:

1. choleretic drugs (Magnesium sulfate, Hofitol);
2. enzymes (Creon, Pancreatin);
3. products with ursodeoxycholic acid (Delursan, Ursolit);
4. enterosorbents (Multisorb, Enterosgel).

If the pathology is severe, threatens with complications, the patient must be hospitalized. In a hospital, detoxification procedures are carried out: hemosorption, plasmapheresis. With a difficult course of pregnancy, the doctor may decide to stimulate labor at 35-37 weeks.

All medicines must be selected with the obligatory consideration of contraindications. Many drugs are prohibited during pregnancy, they can cause unpleasant symptoms, harm both the mother and the fetus.

Diet

For treatment, you should follow a specially designed diet. For the period of treatment, the use of a large amount of liquid is provided. The menu is useful to include cereals, vegetable soups, lean meats, fish.

It is important not to overeat, it is necessary to eat food in small portions and at least 5 times a day. Fried, fatty foods are prohibited. Butter it is required to replace vegetable fats, for example, unrefined sunflower or extra virgin olive oil. Chicken eggs eat no more than one a day.

With stagnation of bile in late pregnancy, you need to eat a lot of fresh vegetables, fruits, berries, herbal infusions. Strong coffee, fatty, smoked, spicy dishes are completely removed from the diet.

Folk methods

It is allowed to combine medical treatment and prescriptions organically traditional medicine. To eliminate the symptoms of cholestasis, cooling compresses, soothing decoctions, and compositions for moisturizing the skin are used.

To combat itching, use a remedy based on medicinal plants. Positive reviews received funds from oregano. Necessary:

• take a tablespoon of oregano, a liter of water, pour boiling water;
• insist for three hours, then strain.

The resulting composition wipes itchy integuments, the duration of the course of treatment is 1 week.

Decoctions of St. John's wort help to improve liver function, the plant has a choleretic effect, quickly cleanses the ducts of the liver and gallbladder. On a glass of boiling water take a tablespoon of St. John's wort. The decoction is taken an hour before meals, the duration of the course of therapy is a week.

Possible consequences, measures to prevent cholestasis

Children born to mothers with pathologies of the liver and biliary tract may lag behind in physical, mental development. They are more likely to get viral, infectious diseases. Children suffer from respiratory diseases, digestive system are susceptible to neuropsychiatric disorders.

If you do not engage in treatment, do not adhere to the recommendations of the doctor appears big risk maternal bleeding. For a child, cholestasis threatens with impaired liver development, since the mother's body is responsible for removing bile from his body. In advanced cases, pathology can cause fetal death.

If the first signs of liver dysfunction occur, a pregnant woman should consult a doctor for advice. For prevention it is necessary:

• lead healthy lifestyle life;
• follow a diet;
• maintain water balance.

It is recommended for a pregnant woman to be observed by a doctor, to donate blood to the liver complex in time, to undergo necessary research. Otherwise, a woman may develop gallstones, liver failure, or even cirrhosis of the liver.

At risk of cholestasis are women with multiple pregnancies, hereditary predisposition to diagnosis, chronic disorders of the functioning of the liver, gallbladder. First of all, it is important for them to prevent all possible risks development of cholestasis.

During pregnancy in female body there are huge changes at the hormonal level. Often these processes provoke the occurrence or exacerbation of cholestasis in pregnant women.

In pregnant women Establishing the diagnosis of ultrasound of the liver
calves doctor pregnant
the doctor's level of accuracy
lying down during pregnancy

Varieties of this disease

Cholestasis is a disease of the liver that occurs when there is a cessation or decrease in the secretion of bile and its entry into the duodenum. Bile is produced by the liver and enters the intestines to aid in digestion. Sometimes this mechanism fails.

This disease can occur not only due to changes in the hormonal background in women. Diseases of the genitourinary system, such as adenoma, tumors, inflammations, urolithiasis stimulate the development of the disease. A genetic predisposition to liver disease also serves as a sign.

There are two main types of cholestasis.

1. Intrahepatic cholestasis of pregnant women, i.e., processes occur in the liver at the cellular level. It is often a consequence of hepatitis, cirrhosis, liver damage from alcohol, hormonal changes or drug reactions. Depending on the symptoms, the following forms can be distinguished: functional - a decrease in the level of bile current in the channels, a decrease in bile acids; morphological - accumulation of bile components in the ducts and liver cells (hepatocytes); clinical - determination of the delay of components in the blood.
2. Extrahepatic, i.e. blockage of the bile ducts outside the liver.

During hormonal changes in the body, the liver in some women weakens, which may cause intrahepatic cholestasis of pregnant women. The development of the disease is affected by hypersensitivity to estrogens - female sex hormones, which is genetically determined.

rare disease

By the end of pregnancy, the level of estrogen in the expectant mother increases many times over. This is the main cause of cholestasis in pregnant women, since estrogens reduce the formation and secretion of bile.

Signs, diagnosis of pathology

Cholestasis of pregnancy is a rare disease, especially for European countries. Most often it manifests itself during the third trimester, starting from the 28th week. Accompanied by the following symptoms:

• dry skin, itching of the extremities (palms, feet) or the whole body;
• sleep disturbance, as a result - fatigue, poor health, stress;
• jaundice may occur mild form manifestations, yellowness of the whites of the eyes;
• with a running variant of the course of the disease, the color of the urine darkens, and the stool, on the contrary, may become lighter.

Because of the characteristic itching, redness, cholestasis is sometimes confused with allergic reaction or skin diseases.

The big problem is that it is not possible to diagnose the disease immediately, but only after 2-3 weeks after the first symptoms appear. To do this, the doctor prescribes to pass clinical analysis blood and blood for biochemistry to determine the amount of bile acids, components - bilirubin and transaminase. According to the results, one can judge the development of cholestasis in a pregnant woman.

In some cases, they are sent for an ultrasound of the liver. In the presence of intrahepatic cholestasis, there is an increase in the liver, as well as the volume of the gallbladder.

Establishing a blood diagnosis

Women at risk include:

• with multiple pregnancy;
• with a genetic predisposition to this disease (cases of cholestasis were observed in the family);
• who previously had a disorder of the liver, gallbladder.

Basic therapies

After diagnosing the disease, the specialist prescribes medication. The choice of therapy depends on the duration, course of pregnancy, the degree of development of cholestasis, as well as the characteristics of the patient's body.

1. According to experts, the best drugs, which include the substance - ursodeoxycholic acid. It helps to improve the circulation of bile acids, stabilizes liver cells. Essentiale forte N is one of the drugs recommended for cholestasis of pregnancy, just because of this substance. It is worth taking only as directed by a doctor if the risk from the disease outweighs the risk to the development of the fetus.
2. Another drug that gynecologists prescribe for complex therapy- Hofitol. The main active ingredient is artichoke leaf extract. With cholestasis, it is not dangerous to take it for pregnant women, since the drug is herbal. Contraindication is the individual intolerance of the organism.
3. To avoid unwanted bleeding after childbirth, gynecologists advise taking vitamins of groups K, A, E and D.
4. Previously, antihistamines were used, but now they are proven to be almost ineffective in this case.
5. Your doctor may recommend a special diet if you have cholestasis in a pregnant woman. It consists of drinking plenty of water, as well as a diet designed for patients with a diseased liver.
6. With a complex course of the disease, the doctor, at his discretion, may decide to stimulate labor at 35-37 weeks.

Folk methods of treatment

Traditional medicine - a treasure trove useful tips. It is often combined with medications or used as an alternative treatment.

But you should never neglect the advice of a doctor, especially a pregnant woman. Only qualified specialist appreciate possible benefit and the harm of treatment with folk remedies.

With cholestasis, there are many ways to relieve symptoms. Cold compresses, soothing decoctions, and moisturizing skin nourishers can help treat itching during pregnancy.

Oregano infusion will help soothe itchy skin:

• take 1 tbsp. a spoonful of oregano, 1 liter of water;
• to boil water;
• pour boiling water over the grass;
• insist 3 hours;
• strain.

Application.

1. Wipe the disturbing areas of the skin with a cotton swab moistened with decoction.

To improve liver function, many advise drinking a decoction of St. John's wort, which has a choleretic effect (taken carefully, only after consulting a doctor):

• take 1 tbsp. a spoonful of St. John's wort, 1 glass of water;
• to boil water;
• fill the grass with water;
• boil over low heat.

Application.

1. Take a decoction one hour before meals.
2. The duration of therapy is 1 week.

Beetroot syrup also helps:

• take 1 large beet;
• clear;
• finely cut;
• cook until syrup is formed.

Application.

1. Take 1 time / 4 hours for 1 tablespoon.
2. The duration of the course is 5 days.

Development Hazards and Prevention

For herself future mother such a disease is not risky. As a rule, all symptoms disappear within a few days after labor, when the liver and gallbladder function normalize. True, there is a high probability of recurrence of the disease in subsequent pregnancies. by the most terrible consequence after the birth of the child are bleeding.

Ultrasound of the liver

Cholestasis of pregnancy has dangerous consequences for a child. Since the mother's liver is responsible for bile secretion in the fetus before birth, liver development disorders in the child after childbirth may occur. There is a risk premature birth. With advanced options, the disease can provoke intrauterine fetal death after 38 weeks.

Therefore, when the first signs of cholestasis occur, a pregnant woman should immediately consult a doctor.

To prevent liver disease during pregnancy, it is recommended:

1. lead a healthy, active lifestyle, observe proper nutrition;
2. observe the water balance, i.e. drink plenty of water, dehydration can also cause bile stasis;
Thank you

Cholestasis of pregnancy, what is this disease? How is it manifested, treated and what can be dangerous for the expectant mother and her child? Let's describe this problem in general terms.

This disease affects the liver and leads to a violation of the production of bile and its outflow. It should be said that this disease is quite rare, especially in Europe and the CIS countries. But it has a tendency to recur. More cases of its diagnosis in Chile, China, Scandinavian countries, Bolivia. The cause of occurrence, most often, is genetically determined, that is, it is not wrong image a woman's life, high fat intake, etc. Although these factors undoubtedly have a negative effect on the liver. Danger this disease lies in big risk for the fetus, with such a pathology, premature birth often occurs, children die in utero and in the first hours of life. For a woman, the danger lies in severe postpartum bleeding.

What are the symptoms of intrahepatic cholestasis of pregnancy, what other diseases does it look like? The first manifestation is usually itching of the feet and hands. In parallel with this, insomnia, nervousness, yellowness of the skin and mucous membranes appear. The woman does not feel pain.

Depending on what symptoms accompany itching during pregnancy, as well as what the test results are, doctors determine the severity of the disease. It should be clarified that, as a rule, it occurs later than 32 weeks of gestation. But there are cases when the disease manifests itself even in the first trimester. In case of intrahepatic cholestasis of pregnant women, treatment is carried out depending on the condition of the woman, the risk to the fetus. At high risk, when the fetus is already viable, if born prematurely, doctors may decide on an emergency delivery.

Doctors know how to recognize cholestasis during pregnancy, but sometimes they are still mistaken ... Similar diseases - viral hepatitis, acute fatty hepatosis of pregnant women, HELLP-syndrome. To make a diagnosis, a woman takes blood tests - biochemical, for serum bile acids, and the second analysis allows you to most accurately determine cholestasis during pregnancy in the late or early stages, it is specific for this disease. It does not hurt to do an ultrasound of the liver and biliary tract. If a woman has cholestasis, then in the conclusion of the ultrasound examination, such points as: non-enlarged liver size, homogeneous liver tissue, increase in volume will be noted gallbladder.

The diet for cholestasis of pregnant women involves the rejection of fatty, fried, smoked - in a word, from all foods that are “heavy” for the liver. It is recommended to reduce the amount of food of animal origin. Eat meat with a low fat content, such as chicken breast. Dairy and dairy products also choose with a small fat content. In general, this diet is similar to the one recommended for high level cholesterol. By the way, with cholestasis in pregnant women, it also tends to increase in excess of the norm.

The danger of cholestasis of pregnant women lies in the risk of premature birth - in amniotic fluid the original feces enter, the consequences of such a pathology are fraught with death.

After conception, global transformations occur in the woman's body, she begins to experience a great load, and also becomes susceptible to various diseases. Changes in hormonal status sometimes lead to complications that are dangerous for her and the child. One of these ailments is cholestasis of pregnancy, which, without timely treatment may cause serious violations and harm expectant mother and child.

This disease affects the liver, thereby disrupting its work, and prevents the production of bile, disrupts its outflow. The disease is quite rare, but it tends to recur. Most often she wears genetic predisposition so poor nutrition or excessive consumption fatty foods nothing here. But these external factors also negatively affect the liver and only exacerbate cholestasis when it occurs.

The main danger of the disease lies in the negative impact on the fetus. Since the disease occurs already in the third trimester of pregnancy, it often ends in premature labor and the child dies in the womb or in the first hours of life. For a woman, cholestasis is dangerous due to the occurrence of bleeding in postpartum period. Only timely therapy and control of specialists can prevent such dangerous complications and keep the pregnancy.

Varieties of cholestasis in pregnant women

The disease is divided into types according to the place of localization, the manifestation of symptoms, outward signs, as well as by the type of occurrence and the presence of cytolysis.

During gestation, intrahepatic cholestasis may develop, which is characterized by stagnation of bile during pregnancy directly in the liver. Or extrahepatic type, when bile lingers in the bile ducts outside the organ.

But cholestasis is also divided into acute and chronic types, when symptoms occur unexpectedly or with periodic relapses with intensification and weakening of the signs of the disease. By external manifestations determine the nature of the disease: it can be icteric, when the mucous membranes and skin become yellow tint, or anicteric, without visible changes.

Cholestasis is divided into subspecies according to the method of destruction of liver cells: it can be cytolytic or non-cytolytic. In addition, the disease can be manifested by a violation of the outflow of bile to the duodenum or a delay in some components of the bile fluid.

Signs of cholestasis during pregnancy

Most often, the disease develops on recent months pregnancy and, as a rule, in the cold season, in autumn or winter.

To the main characteristics cholestasis include severe itching on the feet, palms, neck and face. It can be so intense that it leads to insomnia and disrupts the usual rhythm of life. severe itching can lead to the formation of wounds, if a woman cannot endure and scratches the affected area, the consequence of such combing is the ingress of infections into them.

If the disease is mild or average form, That unpleasant symptom goes away a few days after birth. The hormonal background changes, which is affected by pregnancy, and the work of the liver, as well as the kidneys, returns to normal on its own, and the sign of the disease recedes.

With extensive liver damage, severe cholestasis is observed. Its symptom is similar to that of jaundice. In addition to itching, nausea occurs, yellowness of the sclera, mucous membranes and skin is manifested. Urine is darker, stool becomes white shade, there is no natural choleretic effect.

The danger of cholestasis of pregnant women lies in the risk of premature birth. Then the original feces enter the amniotic fluid, the consequences of such a pathology are fraught with death.

A child can die in the womb as a result of poisoning or after childbirth in the first hours of life. The consequence of liver failure at a high load for a woman in labor is profuse bleeding.

Diagnosis of cholestasis of pregnant women

The discomfort that accompanies the disease is not a basis for making a diagnosis, as it can occur for a number of other reasons. It is common for a pregnant woman to get better, and the skin can stretch, causing itching. To set in a woman dangerous disease cholestasis, it is important to undergo a complete examination.

One of the indicative diagnostic methods is a blood test. It must necessarily include liver tests and analysis for the concentration of bile acids. Since the results of studies on initial stage may be negative, with continued poor health and itching, a re-examination is carried out.

Often, due to the lack of specially equipped laboratories, the diagnosis of cholestasis during pregnancy is made on the basis of the exclusion of other diseases, which greatly complicates the diagnosis and makes it unreliable.

To see the formations that arose as a result of stagnation of bile or stones that blocked the duct, an ultrasound is performed. With cholestasis, it reveals the first sign of liver damage - the organ, as a rule, is enlarged in size, but has a homogeneous structure. But the gallbladder as a result of stagnation of bile becomes noticeably larger.

Only after the diagnosis is clarified, adequate treatment is prescribed and desired scheme therapy, prescribes a choleretic during pregnancy only a doctor.

Methods of treatment of cholestasis of pregnancy

To reduce the risk of complications, a woman is prescribed an unplanned birth when late deadline reaches 36–37 weeks. Until this period, with the appearance of the first signs, symptomatic treatment is carried out and choleretic drugs are prescribed during pregnancy.

Pregnant women are prescribed steroid drugs (Prednisolone) to suppress discomfort and - an agent based on ursodeoxycholic acid. Its use not only suppresses itching, but also restores the functionality of the liver, has a choleretic effect. To reduce the risk of bleeding in a woman in labor, a woman is prescribed vitamin K, which helps the blood to clot. It can also be used - under its influence, dyskinesia of the choleretic tract passes and the production of bile is normalized.

Cholestasis threatens the life of an unborn child, so the task of treatment is to preserve its viability and prevent Negative influence. Throughout the therapy, the condition of the baby and mother is monitored by specialists and the treatment regimen is adjusted if necessary.

As soon as cholestasis in pregnant women begins to recede, the symptoms stop bothering or the lungs open up so that the child can breathe on his own, it is recommended to stimulate tribal activity, choleretic drugs during pregnancy are canceled.

In addition to medical adjustments, other methods are also resorted to. A woman can be prescribed plasmapheresis and extrarenal blood purification from toxic substances using sorbents. This method helps to get rid of itching by removing excess bilirubin from the blood, because the liver enzyme causes discomfort.

Diet for cholestasis of pregnancy

Except, traditional methods treatment to combat the disease is important to adhere to proper nutrition. Diet for cholestasis of pregnant women should be carried out in combination with the main treatment. It is necessary to remove the load from the damaged liver, to cause a choleretic effect. Pregnancy implies balanced diet, but fatty foods, fried foods should be discarded. You should avoid using:

• legumes;
• coffee;
• some vegetables;
• alcoholic beverages;
• rich soups;
• flour products.

Together with food, a pregnant woman should receive everything essential vitamins and micronutrients. Therefore, it is important that the menu contains fresh fruits and juices from them, boiled chicken, low-fat dietary meat, such as rabbit or quail. From sweet, it is better to give preference to honey and jam, and to replace a product such as coffee with weak tea.

Traditional medicine for cholestasis of pregnancy

Women in position are more worried about the child and are afraid to take any medical preparations. Those medicines, which are prescribed for cholestasis in pregnant women, are harmless to the child, but some still remain of their opinion and trust folk methods of treatment more than traditional ones.

Recipes medicinal herbs can cope with unpleasant symptoms, for example, chamomile, its flowers and leaves are brewed into a decoction or an infusion is prepared for external use.

Cholagogue herbs during pregnancy, such as oregano or chamomile, are boiled in water and infused for 5-6 hours, the period can be extended to a day. After that, the agent is filtered, and with the help of a sponge or cotton wool they wipe the place of itching.

For oral administration, a decoction of St. John's wort is also prepared, which are an excellent choleretic agent and are popular with healers.

Despite the variety of medicinal herbs and folk methods therapy, even a harmless herbal product can harm, so treating the disease on your own is dangerous. It is important to consult your doctor before taking any medication.

During pregnancy, the risk of developing many diseases is greatly increased. This is due to a change in the hormonal background in the body of a woman. Sometimes a short treatment with homeopathic remedies is required, sometimes - surgical intervention. And there are ailments that appear suddenly and disappear only after delivery. These include cholestasis. What is this disease? How serious are the consequences? Is there a therapy to help get rid of the symptoms or alleviate them?

What is intrahepatic cholestasis of pregnant women: features of the disease

Bile is a special enzyme involved in the digestion of fats that come with food. It is released reflexively when food begins to irritate the intestinal walls. Promotes the digestive process, enhances intestinal motility.

Cholestasis is a decrease in the release of bile into the duodenum due to a violation of its formation, a change in composition (even one component) or any problems with excretion from the liver through the bile ducts.

Liver tissue during cholestasis

With the development of this disease occurs:

1. The flow of bile into the blood in large volumes.
2. Decreased secretion of bile in the intestines.
3. Toxic effect of bile components on liver and gallbladder cells.

Cholestasis of pregnancy is a rare disease. It occurs in about one percent of women. However, in some countries of South America (Chile, Peru, Brazil) and Scandinavia (Iceland, Norway, Sweden), this figure reaches fifteen percent.

Usually the disease is diagnosed in the third trimester of pregnancy, and immediately after childbirth it disappears. But in about 20-30% of cases, it is detected in the second trimester.

There are two types of cholestasis in pregnancy:

1. Single component. When the formation and secretion of bilirubin (bile pigment) are disturbed, but other components of bile are excreted in a normal volume.
2. Partial choleacid. The defeat of the mechanism of acceptance and secretion of bile acids during the uninterrupted transportation of other components. The prognosis for recovery with this type of cholestasis is always very poor.

Causes and risk factors

The causes of cholestasis are still being discussed by experts. Several of the most likely are:

1. hereditary predisposition. In half of the cases in pregnant women in the family, the presence of the disease in relatives was detected.
2. An excess of the hormone estrogen, the content of which in a woman's body by the end of pregnancy increases 1000 times. There is an assumption that increased sensitivity to the hormone in patients is due to their genetic characteristics.
3. shifts internal organs. During the period of bearing a child, the uterus grows and presses down on the gallbladder and liver, which contributes to the disruption of their work. This theory is also supported by the fact that the disease manifests itself in most cases in the third trimester (36-40 weeks), when the uterus reaches its maximum size.
4. Toxic and drug damage to the liver.
5. Congenital diseases of the liver.
6. Sepsis. Inflammatory process in organs (in this case, in the liver or gallbladder), resulting from blood poisoning. Until 2008, sepsis was the leading cause of maternal death in the UK.

The risk factors arising from the causes are:

1. The presence of close relatives who previously suffered from cholestasis.
2. Multiple pregnancy (the birth of twins or triplets).
3. IVF (in vitro fertilization). As a rule, couples who have used the procedure have several babies at once. That is, it is possible multiple pregnancy. In addition, there is a risk of infection, and this increases the chances of sepsis.
4. The presence of early liver diseases (dysmotility of the biliary tract, Caroli syndrome - congenital dilatation of the bile ducts), including cholestasis.
5. The presence of pregnancies that ended or spontaneous abortion or the birth of a dead child. According to statistics, half of women with idiopathic - occurring independently, regardless of existing lesions - cholestasis had repeated pregnancy. Moreover, a quarter had already had 2-3 pregnancies, which were interrupted by a spontaneous miscarriage for early term, or their baby due to intrauterine hypoxia died in the first month of life.
6. Taking combined (containing two types of hormones - estrogens and progestins) oral contraceptives. Such cases are described in the medical literature, and they are confirmed by practice.

Symptoms

Symptoms of the manifestation of cholestasis are quite specific, therefore, at the very first complaints of the patient, the doctor issues a referral to necessary tests. Signs of the disease:

1. Skin itching that worsens at night. Usually it is a harbinger of jaundice;
2. Jaundice. Yellowing of the skin and whites of the eyes occurs due to an increase in the level of bilirubin in the blood. Appears 2-3 weeks after itching;
3. Darkening of urine to dirty yellow or Brown. This is due to the high content of urobilinogen, a product of bilirubin reduction;
4. Discoloration of feces. A consequence of a lack of bilirubin;
5. Steatorrhea. Feces become very fatty because there is not enough bile, which is involved in the breakdown of fats.
6. Pain in the abdomen: in the right hypochondrium and in the stomach;

In addition to the listed symptoms, which most clearly indicate the disease, others may appear that are common and characteristic of the pregnancy period:

1. Headache.
2. Nausea.
3. Heartburn and flatulence (increased gas formation).
4. Pain in the lower back.
5. Chair disorder.
6. Pancreatitis (inflammation of the pancreatic mucosa).
7. Irritability.
8. Dyspnea.

You should also be aware that the disease can occur with mild symptoms. There are cases when the diagnosis was made to a woman in the first weeks after the birth of a child.

If cholestasis is due to pregnancy, then all signs disappear within 5-7 days.

Gallery: Symptoms during cholestasis

An increase in body temperature is a symptom of cholestasis Pain in the gallbladder area is a symptom of incipient cholestasis Jaundice can be manifested by yellowing of the whites of the eyes Itching is the most common symptom of cholestasis

Diagnostics

The most common type of diagnosis of cholestasis is palpation of the liver. However, due to the fact that during pregnancy the organs shift, and the uterus takes their place, the liver palpation procedure is not always informative. Moreover, at this time it is NOT recommended to use as methods for determining the disease:

• radionuclide liver scan (scintigraphy), when radioactive substances are introduced into the body, which move with the blood to the spleen. By the location of the isotopes and their glow, you can determine where the damage or tumor is located;
• laparoscopy. Examination of the state of organs or even surgery on them using a telescopic tube connected to a video camera through a 0.5–1.5 cm incision in the skin of the abdominal or pelvic cavities;
• computed tomography. It is especially dangerous to carry it out in the first trimester of pregnancy. IN extreme cases the stomach is covered with a special lead screen;
• percutaneous transhepatic cholangiography (PTCG) due to the high likelihood of malformations and deformities in the fetus. It is a fluoroscopic examination after direct injection of an iodine-containing contrast agent into the bile ducts.

That's why traditional ways diagnosis of cholestasis in pregnant women remain laboratory research blood or urine and ultrasound.

Gallery: Types of diagnosis of cholestasis in pregnant women

Biopsy is absolutely safe during pregnancy Ultrasound - safe method diagnosis of cholestasis Urinalysis - one of the ways to diagnose cholestasis in pregnant women Blood test - a method for diagnosing cholestasis

To diagnose cholestasis in pregnant women, the following are prescribed: a complete blood count, a biochemical blood test and a blood test for liver tests.

The last analysis is very important, since it is he who evaluates the work of the liver.

1. Total protein and albumin are directly dependent on the performance of the synthetic function of the liver (metabolism of proteins, fats, carbohydrates).
2. Abnormal bilirubin levels indicate liver damage and bile stasis.
3. Alkaline phosphatase is a marker of bile stasis.

The indicators of alanine transaminase (ALT) and aspartate aminotransferase (AST) are also taken into account. These are enzymes that are contained in the cells of many human organs, but their release into the blood in in large numbers talking about serious problems with heart or liver. The norm of AST and ALT in pregnant women is up to 31 U / ml. However, their level may be slightly elevated due to late toxicosis as well as in the first and second trimester. Therefore, it is often not a direct indicator of the development of cholestasis.

Laboratory research methods are carried out on an empty stomach. You must first refrain from eating for 10-12 hours.

In some cases, a coagulogram is prescribed - a blood clotting test. In pregnant women with this disease, bleeding is possible.

Table: The difference between the norm in the blood and the indicators for cholestasis during pregnancy

For research, a pregnant woman is invited to take a general urine test.

Table: The difference between normal values ​​in urine and indicators for cholestasis during pregnancy

Ultrasound of the liver and gallbladder

The definition of cholestasis using ultrasound of the liver and gallbladder is considered one of the safest for mother and child. It allows you to learn not only about the place where there is an obstacle to the outflow of bile (stone, tumor, neoplasm), but about the expansion of the ducts above this area. You can also see the organs being examined enlarged in volume, which is a manifestation of the disease.

A liver biopsy is usually done in cases where other diagnostic methods have given conflicting or unreliable results. This procedure is relatively safe during pregnancy (although many doctors still prefer to skip it and use other methods). possible ways that do not require intracavitary intervention).

It is carried out under the control of ultrasound. A special biopsy needle is inserted into the body and a small sample of liver tissue is taken. The resulting material is then examined under a microscope. With cholestasis, dilation of the bile capillaries will be visible.

Treatment

The doctor will prescribe complex treatment cholestasis during pregnancy

The treatment of cholestasis is complex and includes the use of medicines, surgery (if necessary), compliance special diet, the use of traditional medicine as maintenance therapy.

However, in some cases, immediate delivery is recommended to rule out oxygen starvation fetus and protect from exposure to bile acids that enter through the placenta and disrupt the functioning of all organ systems. Since the disease is mainly diagnosed in the third trimester (27–40 weeks), the baby is already sufficiently developed for independent living.

Medical treatment

If the doctor believes that the degree of the disease is not high or the pregnancy needs to be extended (for example, the period is still short, but there is a possibility of a birth healthy child), then you can prescribe medication with the following drugs:

1. Ursodeoxycholic acid ("Ursosan", "Ursofalk"). It protects the membrane of liver cells, reduces the content of toxic acids by acting on the gastrointestinal circulation of bile acids, and also lowers blood cholesterol.
2. Enzymes ("Mezim", "Creon", "Festal"). They will help digest food, reducing the load on the liver.
3. "Cholesteramine". It is an ion exchange resin that binds bile acids in the intestine and prevents them from being absorbed. However, it is prescribed only after the 24th week of pregnancy, because its effect on the fetus has not been fully studied.
4. Choleretic from the group of cholecystokinetics (magnesium sulfate). They irritate the mucous membrane of the duodenum, which provokes the production of cholecystokinin, which stimulates the contraction of the gallbladder. Also used "Hofitol" - a herbal preparation.
5. Sorbents ("Enderosgel", "Laktuvit", "Smekta"). They selectively absorb and excrete gastrointestinal tract toxins and heavy metals.
6. Hydrocortisone ointment. Relieves itching of the skin. It should be applied externally, applying to the required areas 2-3 times a day.
7. Vitamin K. Improves blood clotting by preventing bleeding. Its deficiency occurs with prolonged and severe cholestasis.
8. Antioxidants: vitamin E, ascorbic acid.

Related procedures

Plasmapheresis - a procedure for the treatment of cholestasis in pregnant women

In cases where it is not possible to relieve the symptoms of the disease (itching and high concentrations of bilirubin and alkaline phosphatase), special procedures: plasmapheresis and hemosorption.

Contraindications for procedures:

1. Content in the blood total protein <60 г/л.
2. The content of platelets in the blood<140*10^9/л.
3. Diseases of the gastrointestinal tract (peptic ulcer).
4. Blood diseases (hemorrhagic diathesis).

Plasmapheresis technique

It is carried out 4 times. Each procedure removes 600–700 ml of plasma, replacing it with an isotonic sodium chloride solution in a ratio of 1:1.4 (1.4 parts of the solution and 1 part of the plasma).

To prevent blood from clotting, use a solution of sodium citrate (ACD-A) mixed with blood in a ratio of 1:12 (1 part of the solution and 12 parts of blood) at the rate of 150 U / kg of body weight.

The method of carrying out hemosorption

3–3.5 liters of blood is passed through the sorption column, and then it is returned in full to the body of the pregnant woman. The dose of blood that enters the device and then returns back to the body in one cycle is 9 ml. The procedure is carried out once.

For one patient, two sorption columns are used: plasma is saturated in one column and goes to another while the first is restored.

The calculation of the removed plasma is always made individually according to a special formula. For pregnant women, the following plasma substitutes are used: protein, albumin, saline solutions, gemodez.

Traditional medicine

Any traditional medicine during pregnancy should be used only after consulting a doctor. The dosage given is approximate. The doctor should prescribe it individually, based on the degree of the disease. It should also be remembered that some ingredients (dandelion, rosehip) have a diuretic effect, therefore, the load on the kidneys increases.

Dandelion decoction

Warm infusion: a tablespoon of dry crushed dandelion roots must be poured with one glass (200 ml) of hot boiled water, and then boiled for another 15-20 minutes. Cool and strain through cheesecloth (or linen cloth). It is recommended to take in a warm form three times a day for 1/3 cup. Each time you need to prepare a fresh broth.

Cold infusion: Pour 2-3 teaspoons of fresh chopped dandelion root with one glass (200 ml) of cold boiled water. Infuse in the refrigerator for 8 hours. Take three times a day for 1/3 cup. Not subject to storage. Use only freshly prepared decoction.

Decoction of wild rose with nettle

Grind in a blender 20 grams of rose hips (pitted) and 10 grams of nettle leaves. Pour a tablespoon of the resulting mixture with 1 cup (200 ml) of boiling water and cook in a water bath for 15-20 minutes. Cool until completely chilled. Take 200 ml once a day (preferably in the morning) 30 minutes before meals. Use only freshly prepared decoction.

Nettle, rosehip and dandelion are considered safe herbs to take during pregnancy and lactation. They should not be used in case of individual intolerance or in the presence of diseases of the gastrointestinal tract.

With itching during cholestasis, lotions from a decoction of chamomile and oatmeal will perfectly help to cope. Natural ingredients will not only eliminate discomfort, but also have a beneficial effect on the skin of the expectant mother.

Gallery: Traditional medicine for the treatment of cholestasis

Cold infusion of dandelions is the fastest to prepare of all means Warm infusion of dandelions will help in the fight against cholestasis A decoction of nettle and rose hips is not only pleasant to taste, but also very useful in the treatment of cholestasis

Concomitant Diet

For diseases of the liver, gallbladder and biliary tract, diet No. 5 is prescribed.

List of allowed products:

1. Bakery products from flour of the first and second grade.
2. Vegetable soups (except mushroom).
3. Low-fat meats (veal), poultry (chicken, turkey), fish, seafood, dietary sausages ("Doctor's", "Milk"), sausages ("Dairy").
4. Dairy products of low fat content (no more than 4–5%, cottage cheese up to 20% fat content).
5. Eggs cooked in the form of omelettes.
6. Vegetables, stewed or steamed (except radish, sorrel, spinach, radish).
7. Spices: parsley, cinnamon.
8. Sweets: marmalade, honey, jam.
9. Drinks: tea, coffee with milk, vegetable juices, kissels.

Marmalade - allowed sweetness on diet No. 5 Veal - dietary lean meat Fat-free yogurt - a product allowed on diet No. 5 Vegetable soups in the list of "allowed foods"

1. Meat, fish, mushroom broths.
2. Foods rich in oxalic acid and essential oils (bananas, oranges, beets, pomegranates).
3. Fatty meats (pork, lamb), poultry (duck), fish (trout).
4. Everything is fried, smoked, spicy.
5. Dairy products with a high percentage of fat content (milk 6%, cream).
6. Legumes, radishes, mushrooms, garlic. Nuts, seeds.
7. Chocolate, cream products.
8. Alcohol, black coffee, carbonated drinks.

Black coffee is not recommended when dieting. Legumes increase gas formation. Smoked products should be discontinued on a diet number 5. Fresh bread is contraindicated for patients with liver diseases. Fatty foods should be excluded from your diet.

It is also necessary to eat fractionally - every 3-4 hours in small portions, observing the balance of fats, proteins and carbohydrates.

Possible complications and consequences of the disease at different times

The occurrence of cholestasis during pregnancy and untimely diagnosis lead to rather serious consequences for both the mother and the child:

1. Intrauterine fetal death due to hypoxia due to damage to the placenta.
2. The threat of premature birth.
3. The death of a child in the first month of life due to the negative effects of bile acids penetrating the placenta. Or the presence of congenital pathologies.
4. Recurrence of cholestasis in subsequent pregnancies.

An unfavorable prognosis for the course of pregnancy with cholestasis is realized if the disease occurs early (up to 25–27 weeks) and becomes severe.

Preventive measures

Fitness classes and an active lifestyle during pregnancy are essential for a woman's health

Any disease is always easier to prevent than to treat. Therefore, during pregnancy it is recommended:

1. Follow a diet. Firstly, it will help not to gain extra pounds. Secondly, the child will receive the necessary trace elements in sufficient quantities. Thirdly, the load on the internal organs (liver, kidneys, stomach), which are already squeezed by the growing uterus, will significantly decrease.
2. Lead an active lifestyle, find time for light physical activity, such as yoga or swimming. Pregnancy is not a disease, but a natural state for a woman. You don't have to put yourself on bed rest.
3. Timely treatment of diseases of internal organs.
4. In the presence of previous liver diseases, take tests and consult a doctor for supportive therapy.

You should not be afraid if you have intrahepatic cholestasis during pregnancy. It belongs to the group of relatively benign diseases that can be treated and are skillfully controlled by physicians with the help of medicines. Possible consequences and complications always take place. But in order to avoid them, it is necessary not to miss appointments with the doctor; undergo a comprehensive examination by several doctors recommended by gynecologists during the first and second trimesters; when the first symptoms appear, immediately report them, and do not wait for them to disappear or prescribe medications without prior consultation. You are responsible not only for your health, but also for the health of a small, unborn person.