Reduced outflow of bile acids from the liver which resolves after delivery of the baby

Aetiology

• Pregnancy-related hepatobiliary disorder that typically manifests after the 24th week of gestation
• The condition is characterised by impaired bile flow leading to the accumulation of bile acids
• Underlying cause not known, thought to be the result of increased oestrogen and progesterone levels
• There seems to be a genetic component

Risk factors

• More common in women of South Asian ethnicity
• Past history of obstetric cholestasis
• Family history of obstetric cholestasis
• Multiple pregnancy
• Presence of gallstones
• Hep. C

Clinical features

• Usually develops later in pregnancy, particularly in the third trimester
• Pruritus: this is often severe and typically more intense on the hands and feet
  • It is not associated with a rash, although excoriation marks from scratching may be present.
• General discomfort: patients may experience fatigue or malaise.
• Gastrointestinal symptoms: nausea and loss of appetite are common.
• Jaundice: mild maternal jaundice characterised by dark urine and pale stools may occasionally occur
• Abdominal pain: pain is typically localised in the right upper quadrant