Where does it itch during cholestasis of pregnancy

For women, pregnancy is a very dangerous thing, because women may suffer from various pregnancy diseases during pregnancy, which are very harmful to the body of pregnant women. Gestational cholestasis is a common disease among women during pregnancy. This disease is very similar to prurigo. Where does the itch occur due to gestational cholestasis? The following is a detailed analysis of the difference between gestational cholestasis and prurigo.

1. Difference between cholestasis of pregnancy and prurigo: different time of occurrence

Cholestasis of pregnancy: It is an idiopathic disease in the second and third trimesters of pregnancy. More than 70% of cases occur after 28 weeks of gestation, and a small number of cases occur after 14 weeks of mid-gestation.

Pruritus during pregnancy: Early-onset prurigo during pregnancy often occurs in the first half of pregnancy, especially in the third or fourth month of pregnancy. Delayed prurigo of pregnancy often occurs in the last two months of pregnancy, especially within two weeks before delivery.

2. Differences between cholestasis of pregnancy and prurigo: different symptoms

Cholestasis of pregnancy: This is itching without skin damage, usually starting from the palms and soles, then gradually extending to the proximal limbs and even to the face. The itching is mild during the day and worse at night. A small number of patients experience gastrointestinal symptoms such as yellowing of the whites of the eyes and skin (jaundice), nausea, vomiting, diarrhea, and loss of appetite. Prurigo of pregnancy: Early-onset prurigo of pregnancy will cause papules to appear on the body, mostly on the extensor sides of the limbs, upper trunk, upper arms, and thighs. They are symmetrically distributed on both sides, round, millet- to mung bean-sized, slightly flat at the top, white at first, and later turn dark red, light red, or normal skin color. Delayed prurigo gestationis may also present with papulovesicular and urticaria-like rashes, which resemble erythema multiforme and often occur first on old stretch marks on the abdominal wall and then quickly spread to the whole body.

Treatment of cholestasis of pregnancy

1. General treatment: Proper bed rest, sleeping in the side-lying position to increase placental blood flow, oxygen, hypertonic glucose, vitamins and energy are given to protect the liver and improve the fetus' tolerance to hypoxia. Regularly check liver function and blood bile acid to understand the condition.

2. Drug treatment: It can alleviate the clinical symptoms of expectant mothers, improve the biochemical indicators of cholestasis and the prognosis of perinatal infants. Commonly used drugs include:

(1) Ursodeoxycholic acid (UDCA): The usual dose is 1 g per day or 15 mg/(kg·d). During treatment, liver function was checked every 1-2 weeks to detect changes in biochemical indicators.

(2) S-adenosylmethionine (SAMe): The dosage is 1 g per day by intravenous drip, or 500 mg orally twice a day.

(3) Dexamethasone: Suitable for expectant mothers before 34 weeks of pregnancy and expected to give birth within 7 days. The general dosage is 12 mg per day for 2 consecutive days.

3. Obstetric treatment

(1) Antenatal monitoring: Non-stimulated fetal heart rate monitoring (NST) should be performed weekly starting from the 34th week of pregnancy. Fetal biophysical assessment should be performed when necessary to detect latent fetal hypoxia as early as possible. Those with serious conditions will be admitted to the hospital in advance to prepare for delivery. However, the value of NST in predicting intrauterine fetal death in patients with ICP is limited.

(2) Timely termination of pregnancy: Cholestasis of pregnancy is not an indication for cesarean section. However, because cholestasis of pregnancy is prone to acute fetal hypoxia and stillbirth, there is currently no effective test to predict fetal hypoxia. Most scholars recommend that patients with cholestasis of pregnancy induce labor at 37-38 weeks, actively terminate the pregnancy, and strengthen fetal monitoring during delivery. If treatment is ineffective for severe cholestasis of pregnancy combined with multiple births, severe preeclampsia, etc., cesarean section can be performed to terminate the pregnancy.