It's no secret that during pregnancy the body of a woman experiences very heavy loads. Moreover, a sharp change in the hormonal background often leads to some complications. In modern obstetrical practice, sometimes there is a disease called cholestasis of pregnant women. In the absence of timely therapy, this condition can be dangerous for a growing child and for the mother's body.
That's why many future mothers are interested in questions about what this disease is and why it arises. What are its main symptoms? What kind of treatment can modern medicine offer? Are there effective methods of prevention? This information will be interesting to many readers.
What is cholestasis?
Cholestasis of pregnant women is a disease that is accompanied by a dystrophic lesion of liver tissue. A similar disorder occurs against the background of an increase in the sensitivity of hepatocytes to sex hormones, the level of which changes significantly during the bearing of the child. The result of this process is a
Many future mothers are faced with a similar diagnosis. But do not be scared immediately, because in most cases with cholestatic hepatosis( another name for the disease) can be managed with the help of conservative medicine without causing any harm to the body of a woman or a child.
Prevalence of the disease
Immediately it is worth noting that in some countries this violation is indeed very common. For example, according to statistical studies, in the territories of Scandinavia, China, Bolivia and Chile, many future mothers suffer from this disease. But in Sweden for 10 thousand pregnant women there are no more than 40 cases of such a disease.
In Russia, cholestasis during pregnancy is also considered a relatively rare complication - its frequency does not exceed 2%.The exception is only the northern regions of the country, where the disease is diagnosed much more often. Based on such data, scientists suggest that the groups of risk can be attributed to the ethnicity of women.
The main causes of the development of the disease
In fact, today it is not completely known why the intrahepatic cholestasis of pregnant women develops. There are many theories and studies that can distinguish three main groups of reasons:
- Hepatocyte sensitivity to the group of sex hormones, which is due to genetic characteristics;
- congenital abnormalities of normal enzyme synthesis, which provide transport of bile components from hepatocytes to the bile ducts;
- is a congenital disorder of normal bile acid synthesis, associated with a deficiency of certain enzymes. In turn, such a disorder leads to the formation of atypical bile acids.
It should be noted that in patients with a genetic predisposition or congenital disorders, cholestasis is observed not only during pregnancy, but also at any change in the level of sex hormones( for example, during menstruation, oral contraceptives).
Pathogenesis of cholestasis. What happens during illness?
Cholestasis of pregnant women is accompanied by three main disorders:
- increase in the level of bile in the blood;
- decrease in the amount of secretion in the intestine;
- toxic effects of bile on liver cells and biliary tubules.
Disturbance of 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 in normal pregnancy. And in the presence of birth defects, the risk of dystrophic changes in the filtering organ is significantly increased. In addition, the excess of sex hormones affects the pituitary gland, reducing its activity. In turn, the change in the work of this gland affects the processes of liver secretion of bilirubin and cholesterol. This leads to a violation of the mechanisms of formation and secretion of bile.
Classification of the disease
To date, there are many classification systems for this disorder. For example, depending on the severity of symptoms, the lung, middle and severe forms of the disease are isolated.
By the nature of the course of cholestasis can be both acute and chronic( with chronic illness, the aggravation develops during pregnancy).Depending on the etiology, extrahepatic( develops in the form of obstruction of the bile ducts) and intrahepatic cholestasis( this form is found in pregnant women) is isolated.
Cholestasis of pregnant women: symptoms and signs
Any abnormality during this period of life requires an examination and a doctor's consultation. So how does cholestasis look pregnant?
Symptoms of the disease usually begin to bother in the third trimester( 28-35 weeks).The main manifestation of the disease is itchy skin, and it can have a different degree of severity. Some patients suffer this disorder easily, while others suffer from constant, painful discomfort.
Itching becomes more pronounced at night, which leads to insomnia and, consequently, constant fatigue, increased irritability, emotional disorders. Most often this sensation is localized on the skin of the hands, forearms, shins and anterior abdominal wall. Cholestasis of pregnant women( photo of which is presented in medical manuals) leads to excoriation of the skin, as women damage them as a result of constant scratching.
Other symptoms of the disease include jaundice. According to statistical studies, this disorder is observed in 10-20% of women. As a rule, all signs of impairment disappear by themselves 1-2 weeks after birth. Nevertheless, they can resume on the background of subsequent hormonal failures( for example, during the second pregnancy).
Basic diagnostic methods for
If you have any abnormalities, you should immediately consult a doctor. First, the specialist will collect a complete history and will conduct a physical examination. In some women, small jaundice and characteristic staining of the eye sclera can be noted. When examining the skin you can see redness, abrasions caused by combing the skin.
All these signs indicate that the patient may have cholestasis of pregnant women. Analyzes of serum bile acid concentrations can confirm suspicions of liver abnormalities. There are also various biochemical studies on the content and activity of liver enzymes. Ultrasound is also indicated, during which an increase in the volume of the gallbladder is noted along with normal liver size and uniform echogenicity.
What are the complications of the disease?
In modern medical practice often face a problem called cholestasis of pregnant women. Is this a dangerous situation? Of course, yes. Although here everything depends on the severity of the pathological process, the time of diagnosis, the selected therapy, etc.
Nevertheless, the risk always exists. Violation of the formation and excretion of bile affects metabolic processes. With such a disease, the probability of premature birth is high. In addition, the percentage of postpartum haemorrhage among parturients with a similar diagnosis is also significantly higher, which is associated with a violation of vitamin K metabolism and some coagulation factors.
If there is a serious malfunction in the liver, there is a risk of fetal death, so in some cases, doctors recommend urgent birth.
Medication for pregnancy
Therapy depends on the severity of the disease and the individual characteristics of the patient. As a rule, vegetative hepatoprotectors are first prescribed, which protect the liver from damage and do no harm to the body. For example, "Hofitol" with cholestasis of pregnant women gives good results. In addition, Gepabene is used in therapy.
In addition to herbal medicines, synthetic hepatoprotectors, in particular Ademethionine, are also used. As antioxidants in pregnancy, prescribe tocopherol acetate( vitamin E), as well as ascorbic acid( vitamin C).In addition, it is necessary to take enterosorbents to bind excess bile acids in the intestine. An effective and harmless drug is Polyphepan. The course of therapy includes drugs that facilitate the outflow of bile and reduce the level of bile acids in the blood. In particular, medications containing ursodeoxycholic acid, for example Ursosan, are used.
Cholestasis of pregnant women: treatment with non-medicinal products
In addition to medicines, some other therapeutic procedures are also used. In particular, pregnant women are often prescribed a course of plasmapheresis and hemosorption. Similar procedures are designed to remove excess bilirubin and pruritogen from the blood, which cause itching. Such manipulations give a really good result. The full course of treatment, as a rule, consists of four procedures of plasmapheresis and one hemosorption.
The right diet is an important part of
therapy. Undoubtedly, after diagnosis the doctor will choose the most effective and harmless medications. But an equally important part of therapy is diet. When cholestasis of pregnant women should first of all worry about the diet, which will reduce the burden on the liver.
Patients are advised to reduce the amount of animal fats. In particular, you need to minimize the use of fatty varieties of meat, butter, dairy products. Also should be discarded of 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 vegetable origin( olive oil, etc.).
Green tea, coffee and cholagogue drinks are also contraindicated. Specialists recommend for a while to abandon eggs, olives, beans, avocados, pickled products, radishes, melons, colored and Brussels sprouts.
The diet should nevertheless be saturated with vitamins and minerals, which can be obtained from fresh fruits and vegetables - they should be the basis of dietary nutrition. It is allowed to eat porridge, fish, low-fat meat. Useful foods that contain high doses of vitamin C, in particular oranges, spinach, herbs, decoction from rose hips, etc., should be eaten often, but in small portions. It is also important to maintain a fluid balance.
Are there effective prevention measures?
Many women are interested in questions about whether it is possible to somehow prevent cholestasis of pregnant women. Unfortunately, there are no means that can protect against such violations. Therefore, patients who are at risk, recommend close monitoring throughout pregnancy.
Even before the first symptoms appear, women are prescribed the use of soft hepatoprotectors, antioxidants and choleretics. It is also very important to observe 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 cope with the symptoms? Recommendations of
patients Many women are faced with a diagnosis of "cholestasis of pregnant women".The patients' testimonies indicate that the treatment really helps to eliminate the disturbances and maintain a healthy fetus. Nevertheless, constant itching significantly impairs the quality of life.
You can fight this feeling with special compresses. For example, lotions and masks from decoction of chamomile or oat flakes help to eliminate discomfort, and also positively influence the appearance of the skin, relieve inflammation. Also, lotions from simple cold water help, since low temperature slows down blood flow, reducing itching. Patients also recommend sleeping in a ventilated, cool area and, of course, carefully follow the diet.