Obstetric cholestasis, anyone? What symptoms? Which week did it start?

[Sandrine1982]

Hi there. I'm 26 weeks pregnant and in the past few days I have been itching like crazy. The itching is worse in the folds of the skin (between fingers, groin, inner thighs..) but it can happen anywhere like on the belly, back, arms and legs. I do seem to have some sort of rash around my fingers which looks like a heat rash but it's not everywhere.
I'm booked in for a blood test in 2 weeks but I wonder if I should call the hospital and rearrange to have it earlier.

If you have / had OC, which week of gestation did the itching start? Which parts of the body? What other symptoms did you have? What remedies did you use?

Thanks in advance. x

PS: also, does it always start on the palms of your hands and soles of your feet??

I had OC/ICP (different people call it different names) when I was pregnant. It's actually not that big a deal even though it sounds dramatic as pretty much the only thing that will stop it is getting the baby out, so all they can do is give you some medication to hopefully prevent it getting worse, monitor your bloods and give you some cream for the itching. Therefore if you do actually get "diagnosed" with it now or in 2 weeks time won't make that much difference to your care. In my trust once you get beyond 37 weeks you're put on an OC pathway with very regular blood tests which will determine when they want to get baby out if it hasn't already arrived but I have no experience as I went into labour naturally at 36+6. They won't let you go overdue due to the risk of still birth and were discussing inducing me at 39 weeks which we were going to try and push back to 40 weeks depending on the bile count.

My midwife did the initial bloods for me at my 32 week appointment and then I went to the day assessment unit in the maternity unit for all of the others. It's most common in the later stages of pregnancy so I'd be surprised if it was OC, particularly given you say you're itching everywhere. For me it was just the soles of my feet which itched and only at night, which apparently is classic symptoms of OC.

The aqueous cream I had is called Dermacool. I believe you can buy it over the counter although I was given several tubs on prescription when they diagnosed it. It went away immediately after I had my baby.

I had this with my first at 32 weeks started on my wrists then it was everywhere, I would contact your antenatal unit and get seen sooner so they can start monitoring if it is icp you will need weekly bloods to monitor the condition, levels below 100 are considered mild and delivery by 37/38 weeks. The medication they give you is Urso which it to help protect the baby from the bile acids which transfer across the umbilical cord, there is an increased risk of stillbirth when unmonitored. Please get yourselves checked out, icp support/itchy mums is great advice on Facebook

I was 34 weeks first time and 22 weeks second time. Induced at 37 weeks both times.

Itching on palms of my hands and soles of my feet first, then arms and legs generally. Unbearable at night especially.

Hope you get tests soon Op.

I noticed the itching (legs and feet) at around 35 weeks then was induced at 37 weeks. All went smoothly and baby was fine.

Oh other symptoms can include dark urine/pale stools/ ruq pain itching can start anywhere and the level of itching does not correlate with the bile levels so it could be intense and be low levels or the other way around.

Oh thanks. I've just called them and they don't think it's OC but they said they can add on a liver function test to the blood tests I've got booked on the 8th of June. Meantime they sent me to the GP...

One more question, has anyone experienced initial itching elsewhere and not necessarily on palms and soles of feet?
Mine started in skin folds (back of knees, groin area, fingers and wrists, now also around the breasts and on the back..).
Thanks

I had ICP/OC in my pregnancy. My palms and soles of feet did itch but it was my legs and top of my feet that were the worst. I still have scars now from it over a year on (from my non stop scratching!). I was finally diagnosed about 33weeks and got medication paired with piriton (they prescribed me thus as don't think it's always recommended during pregnancy).

My best relief was putting my feet in ice cold water and that seemed to calm the itchy feeling temporarily all over my body. They suggested calamine lotion but that made my itch worse!

As for treatment other than the meds, I was just monitored regularly blood tests and CTGs and had to keep an even more careful eye on baby's movements. Any change I had to alert them immediately. They told me I had to be delivered prior to 39 weeks due to condition so had to have a c section at 38+4. Baby completely fine!

Not a big deal? It can cause pre term labour or still birth. I'd say it's a pretty massive deal.

Not to frighten you op and of course majority of women are managed well with medication.

@Sandrine1982 yes mine started on the wrists and then occurred literally everywhere it’s not just hands and feet. If it’s getting more intense ask if you can get a blood test sooner then at least you will know. Also you can get itching before the levels show up in the blood test so important to keep testing if you still have the symptoms. Icp support and itchy mums/icp care are great support groups on Facebook

I had itching which was mostly on my body, arms and legs at 23 weeks. It was treated as a penicillin allergy (spoiler alert: it looks like it was a penicillin allergy), but both the walk-in centre doctor (I was away from home when it happened) and my regular GP, a week or so later, did the appropriate blood tests to rule out the liver thing. Neither deemed it appropriate to wait for the test. (Apparently it’s good to have a second test a week or so later if the itching persists, just in case the levels hadn’t really got going the first time - once the second test was clear, they decided I was fine.)

I’d try to get the first test sooner, if possible. Your 8th June test (is that right?) can then be the second test.

I was treated with piriton and Eurax cream. I self-treated with E45 moisturiser and calamine cream (nicer to use than the lotion - got mine from Sainsbury’s), both of which seem to be safe to use in pregnancy. Having had many severe itching experiences over the course of my life, I’d advise adding in additional creams and using many different remedies to hit the itching from several different angles. I found that gel ice packs for sports injuries held against my legs made me less frantic, for example. I liked how the piriton reduced the itching, but felt like it made baby drowsy, so I used as little as I could (every other day worked for me after a few days), and stopped before I’d finished the course.

Good luck! Itching is horrible, whatever the cause.

Mine started on my stomach and upper legs and later spread to my hands and feet. I found some midwife's were really ill informed about OC, I would push for a test earlier. I was prescribed medication, had at least weekly check ups at the hospital. Cream did bugger all & they admitted the only thing the antihistimanie did was help me sleep a little due to their sedative element. I used to have to sleep with ice packs (the ones you get from first aid kits) on my hand and feet, ice cold footbaths helped too. I remember going to see Jesus Christ Superstar at the theatre & having to sit with ice packs strapped to my feet throughout the performance!! I've experienced nothing like the itching it was insane, I ended up having to be signed off work early as couldn't sleep and was so uncomfortable. I was induced at 38 weeks and stopped as soon as she was born.
Good luck with it all, the risks for baby are really low if the condition is monitored properly although it all sounds quite scary at the time.

Oh and I was diagnosed about 28 weeks but I think probably started about 25/26 weeks pregnant.

Thanks all. I just had a private blood test today which includes the liver function + the bile acids tests. Fingers crosses for the results x

Hope it’s good news and you can relax once you know. I’ve just started itching with my second, am 32 weeks going to ring up for a blood test in the morning, the results come back pretty quick I think

Update My results just came back, all normal, yay! The total bile acids level was just 2 :-)

Oh well, I don't know what might be causing the itching then. Probably some sort of candida overgrowth or something like that. I'll continue my research ..

xx

I had severe itching in my first pregnancy, mainly on my upper arms and shoulders, and the docs wouldn't give me a blood test, but all was fine. Started again in my 2nd pregnancy and mentioned to one of my midwives and she told me she had had it and believed it was a reaction to the baby's male hormones, and lo and behold I had a second boy! Third pregnancy, no symptoms until about 30 weeks, so thought I might be having a girl, but then they started again, and another boy!

Oh haha this is interesting. But I'm having a girl ... hmm...

Old wives tale possibly then! I sympathise though, as one of mine was through a really hot summer, and it was unbearable as I was commuting as well...

That’s good news just bear in mind the itching can start before the levels show as risen in the blood so if it continues ask for another.

@Mayjane5 Thanks, yes I'm definitely keeping an eye on this ;)