It's no secret that during pregnancy a woman's body experiences very heavy loads. Moreover, a sharp change in the hormonal background often leads to certain complications. In modern obstetric practice, a disease called cholestasis of pregnancy is sometimes encountered. In the absence of timely therapy, such a condition can be dangerous for both the growing child and the mother's body.
That is why many expectant mothers are interested in questions about what this disease is and why it occurs. What are its main symptoms? What treatment can modern medicine offer? Are there effective methods of prevention? This information will be of interest to many readers.
What is cholestasis?
Cholestasis of pregnancy is a disease that is accompanied by degenerative damage to liver tissues. Such a violation occurs against the background of increased sensitivityhepatocytes to sex hormones, the level of which changes significantly during childbearing. The result of this process is a violation of the normal metabolic processes of cholesterol and bile acids. As a rule, in women with a similar diagnosis, there is a change in bile formation, as well as failures in the normal outflow of bile, which, accordingly, affects the work of the whole organism.
Many expectant mothers are faced with a similar diagnosis. But do not immediately be afraid, since in most cases cholestatic hepatosis (another name for the disease) can be de alt with using conservative medicine without causing any harm to the body of a woman or child.
Disease prevalence
Immediately it should be noted that in some countries this violation is really very common. For example, according to statistical studies, in Scandinavia, China, Bolivia and Chile, many expectant mothers suffer from a similar disease. But in Sweden, there are no more than 40 cases of such a disease for every 10,000 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 ethnicity of a woman can be attributed to risk groups.
Main causes of disease development
In fact, today it is not completely known whyPrecisely intrahepatic cholestasis of pregnant women develops. There are many theories and studies, thanks to which three main groups of causes can be distinguished:
- increased sensitivity of hepatocytes to a group of sex hormones, which is due to genetic characteristics;
- congenital disorders of the normal synthesis of enzymes that ensure the transport of bile components from hepatocytes to the bile ducts;
- a congenital disorder of the normal synthesis of bile acids associated with a deficiency of certain enzymes. In turn, this 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).
Pathogenesis of cholestasis. What happens when you are sick?
Cholestasis of pregnancy is accompanied by three main disorders:
- increase in the level of bile elements in the blood;
- reducing the amount of secretion in the intestines;
- toxic effect 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 defectsthe risk of dystrophic changes in the filtering organ is significantly increased. In addition, an excess of sex hormones affects the pituitary gland, reducing its activity. In turn, a change in the functioning of this gland affects the processes of excretion of bilirubin and cholesterol by the liver. This leads to a violation of the mechanisms of formation and excretion of bile.
Disease classification
Today, there are many classification systems for this disorder. For example, depending on the severity of symptoms, there are mild, moderate and severe forms of the disease.
According to the nature of the course, cholestasis can be both acute and chronic (with a chronic illness, an exacerbation develops against the background of pregnancy). Depending on the etiology, extrahepatic (develops in the form of obstruction of the bile ducts) and intrahepatic cholestasis (it is these forms that occur in pregnant women) are distinguished.
Cholestasis of pregnancy: symptoms and signs
Any deviation from the norm during this period of life requires examination and consultation with a doctor. So what does cholestasis of pregnancy look like?
Symptoms of the disease, as a rule, begin to disturb in the third trimester (28-35 weeks). The main manifestation of the disease is pruritus, and it can have varying degrees 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, increasedirritability, emotional disorders. Most often, this sensation is localized on the skin of the hands, forearms, legs and anterior abdominal wall. Cholestasis of pregnancy (photo of which is presented in medical reference books) leads to excoriation of the skin, as women damage them as a result of constant scratching.
Jaundice can be attributed to other symptoms of the disease. According to statistical studies, a similar disorder occurs in 10-20% of women. As a rule, all signs of the disorder disappear on their own 1-2 weeks after birth. However, they can reappear on the background of subsequent hormonal disruptions (for example, during a second pregnancy).
Basic diagnostic methods
If there are any abnormalities, you should immediately consult a doctor. First, the specialist will take a complete 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 can notice redness, abrasions caused by scratching the skin.
All these signs suggest that the patient may have cholestasis of pregnancy. Serum bile acid concentration tests can confirm suspicions of abnormal liver function. Various biochemical studies are also carried out on the content and activity of liver enzymes. An ultrasound is also indicated, during which an increase in the volume of the gallbladder is noted along with normal liver sizes and homogeneous echogenicity.
What complications canbring disease?
In modern medical practice, a problem called cholestasis of pregnancy is often encountered. Is this condition dangerous? Certainly yes. Although everything here depends on the severity of the pathological process, the time of diagnosis, the selected therapy, etc.
However, there is always risk. 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 hemorrhage among women with a similar diagnosis is also significantly higher, which is associated with impaired vitamin K metabolism and some coagulation factors.
In severe liver failure, there is a risk of fetal death, so in some cases, doctors recommend emergency delivery.
Medication during pregnancy
Therapy depends on the severity of the disease and the individual characteristics of the patient. As a rule, plant hepatoprotectors are first prescribed, which protect the liver from damage and do not harm the body. For example, "Hofitol" with cholestasis of pregnant women gives good results. In addition, the drug "Gepabene" is used in therapy.
In addition to herbal medicines, synthetic hepatoprotectors are also used, in particular Ademethionine. Tocopherol acetate (vitamin E) and ascorbic acid (vitamin C) are prescribed as antioxidants during pregnancy. In addition, it is necessary to take enterosorbents to bind excess bile acids in the intestine. Polyphepan is considered an effective and harmless drug. The course of therapy includes drugs that facilitate the outflow of bile and reduce the level of bile acids in the blood. In particular, medicines containing ursodeoxycholic acid are used, such as Ursosan.
Cholestasis of pregnancy: non-drug treatment
In addition to drugs, some other therapeutic procedures are also 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 blood that cause itching. Such manipulations give really good results. The full course of treatment usually 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 means of treatment. But an equally important part of therapy is diet. With cholestasis of pregnancy, 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 fats. In particular, it is necessary to limit the consumption of fatty meats, butter, and dairy products as much as possible. You should also give up mayonnaise, sauces and fried foods. Since fats are still 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 giving up eggs, olives, legumes, avocados, pickled foods, radishes, melons, cauliflower and Brussels sprouts for a while.
The diet, however, should be saturated with vitamins and minerals that can be obtained from fresh fruits and vegetables - they should be the basis of dietary nutrition. It is allowed to eat cereals, fish, lean meats. Foods containing high doses of vitamin C will be useful, in particular oranges, spinach, greens, rosehip broth, etc. You need to eat often, but in small portions. It is also important to maintain fluid balance.
Are there effective prevention measures?
Many women are interested in questions about whether it is possible to somehow prevent cholestasis of pregnancy. Unfortunately, there are no means capable of protecting against such violations. Therefore, patients who are at risk are advised to be closely monitored throughout pregnancy.
Even before the first symptoms appear, women are prescribed mild hepatoprotectors, antioxidants and choleretics. It is also extremely important to follow the right 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 deal with symptoms? Recommendations from patients
Many women are diagnosed with cholestasis of pregnancy. Patient reviews indicate that the treatment really helps to eliminate disorders andkeep a he althy fetus. However, persistent itching significantly impairs quality of life.
You can fight this feeling with the help of special compresses. For example, lotions and masks made from decoction of chamomile or oatmeal help eliminate discomfort, and also positively affect the appearance of the skin, relieve inflammation. Plain cold water lotions also help, as the low temperature slows down blood flow, reducing itching. Patients are also advised to sleep in ventilated, cool rooms and, of course, diet carefully.
