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Clinical features

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Clinical features

Pruritus in pregnancy is common, affecting 23% of pregnancies, of which a small proportion will have obstetric cholestasis (1)

  • pruritus of obstetric cholestasis is typically worse at night, is often widespread and may involve the palms of the hands and/or the soles of the feet
  • women present with pruritus without rash, characteristically after 30 weeks' gestation
  • pruritus often worsens as the pregnancy progresses

pruritus that involves the palms and soles of the feet is particularly suggestive

  • steatorrhoea and dark urine may occur
  • jaundice is a rare symptom (2)
  • increased rates of postpartum haemorrhage have been postulated to be due to vitamin K deficiency
  • gallstones may be present more often in affected women
  • women with hepatitis C infection have a higher incidence of intrahepatic cholestasis of pregnancy (2)
  • preeclampsia and gestational diabetes are seen more commonly in women with intrahepatic cholestasis of pregnancy (2)

Reference:

  1. Royal College of Obstetricians and Gynaecologists (April 2011). Guideline No. 43 - Obstetric cholestasis.
  2. Walker KF et al. Pharmacological interventions for treating intrahepatic cholestasis of pregnancy. Cochrane Database of Systematic Reviews 2020, Issue 7. Art. No.: CD000493. DOI: 10.1002/14651858.CD000493.pub3.
  3. BMJ 1994;309:1243-1244
  4. BMJ. 2002 Jan 19;324(7330):123-4

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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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