Why do my limbs itch during late pregnancy?

The late pregnancy is a very important period. Any abnormality in the pregnant woman's body at this time will be taken seriously. In the late pregnancy, some pregnant women will experience itching symptoms on their bodies, especially itching starting from the limbs, so you should be vigilant. The itching may gradually spread and the scope of itching will begin to expand. So, what causes itchy limbs in late pregnancy? Let’s take a look below.

Intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis of pregnancy (ICP) is a unique complication of the second and third trimesters of pregnancy, clinically characterized by skin itching and elevated bile acid levels. It mainly harms the fetus and increases perinatal morbidity and mortality. The greatest threat of this disease to pregnancy is the unpredictable sudden fetal death, and the risk is related to the severity of the disease. This disease is recurrent and may disappear quickly after the current delivery, but it often recurs during the next pregnancy or when taking oral estrogen contraceptives. The incidence of ICP is 0.8% to 12.0%, with obvious regional and racial differences. The incidence is higher in Shanghai and Sichuan Province in China.

Clinical manifestations

1. Itching

The first symptom in almost all patients is itching without skin damage in the late pregnancy. About 80% of patients experience itching after 30 weeks, and some even earlier. The itching varies in severity and is often persistent, milder during the day and worse at night. The itching usually starts from the palms and soles, then gradually extends to the proximal limbs and even to the face, but rarely invades the mucous membranes. The itching symptom lasts for an average of about 3 weeks, but may last for several months. It will quickly ease and disappear within a few hours or days after delivery.

2. Other symptoms

Severe itching can cause insomnia, fatigue, nausea, vomiting, loss of appetite, etc.

3. Physical signs

Scratches can be seen on the skin of the limbs; 10% to 15% of patients develop mild jaundice within a few days to weeks of the onset of itching. In some cases, jaundice and itching occur simultaneously and disappear within a few days after delivery. At the same time, there are symptoms of hyperbilirubinemia such as darker urine color. Pregnant women with ICP have no signs of acute or chronic liver disease, and their livers are enlarged but soft with mild tenderness.

treat

The purpose of treatment is to relieve itching symptoms, restore liver function, and lower blood bile acid levels, with the focus on monitoring the fetal intrauterine condition, promptly detecting fetal hypoxia and taking appropriate measures.

1. General treatment

Provide adequate bed rest, lying on the left side to increase placental blood flow, and give intermittent oxygen inhalation, hypertonic glucose, vitamins and energy mixtures to protect the liver and improve the fetus' tolerance to hypoxia. Regularly recheck liver function, blood bile acid, and bilirubin.

2. Medication

Drugs that can alleviate clinical symptoms of pregnant women, improve biochemical indicators of cholestasis and perinatal prognosis include:

(1) Adenosine methionine is the drug of choice for the treatment of ICP. This drug can prevent cholestasis caused by elevated estrogen and protect the liver of estrogen-sensitive people. Clinically, it can improve the symptoms of ICP and delay further progression of the disease.

(2) After taking ursodeoxycholic acid, it inhibits the intestinal reabsorption of hydrophobic bile acid, reduces bile acid, improves the fetal environment, and thus prolongs gestational age. Both itching symptoms and biochemical indicators were significantly improved.

(3) Dexamethasone can induce enzyme activity, reduce the secretion of fetal adrenal dehydroepiandrosterone through the placenta, reduce the production of estrogen, and alleviate cholestasis; it can promote fetal lung maturation and prevent respiratory distress syndrome in premature infants; it can relieve or even eliminate itching symptoms.

(4) Phenobarbital: This drug can induce enzyme activity and produce cytokine P450, thereby increasing bile flow and improving itching symptoms.

3. Obstetric management

(1) Prenatal monitoring: Non-stimulated fetal heart rate monitoring (NST) tests should be performed weekly from the 34th week of pregnancy, and fetal biophysical assessment should be performed when necessary to detect latent fetal hypoxia as early as possible. The disappearance of NST and baseline fetal heart rate variability can be used as indicators to predict fetal hypoxia in ICP. Count the fetal movements every day. If there are less than 10 movements within 12 hours, you should be alert to fetal distress. Regular ultrasound examinations should be performed to check for oligohydramnios.

(2) Timely termination of pregnancy: If a pregnant woman develops jaundice, the gestational age has reached 36 weeks, there is no jaundice, the pregnancy is full-term or the fetal lungs are mature, there is a significant decrease in placental function or fetal distress, the pregnancy should be terminated promptly. Cesarean section should be preferred, as vaginal delivery will aggravate fetal hypoxia and even death.