“I’m 34 this year and have two kids. My older child, Claudia, is 2, and my baby boy, Jerome, is 4 months old.
I had obstetric cholestasis when I was pregnant with my son. It started during my 33rd week of pregnancy ― I suddenly developed a general itch at my arms, fingers, shoulders and back.
Because I have a history of dry skin and eczema, I simply attributed it to that.
However, the strange thing was that there was no rash ― and yet the itch persisted. My husband then urged me to get my gynaecologist to check it out.
Based on my symptoms, my gynaecologist suspected that it was obstetric cholestasis. When he mentioned the term, I remembered that I had developed a rash on my back towards the end of my first pregnancy, too.
During that time, I didn’t get it checked out with my gynaecologist till I delivered, but my doctor did a blood test and the diagnosis then was cholestasis, as well.
So, it seemed that history was repeating itself ― this time round, the symptoms appeared earlier, and they were definitely more obvious.
My doctor explained to us what obstetric cholestasis was. This condition, which happens in late pregnancy, is essentially a blockage in the normal flow of bile because of the way the liver works when a woman is pregnant.
When the normal flow of bile is blocked, it starts to build up, and some of it leaks into the bloodstream ― this can make the skin very itchy, which was what I experienced. The condition is rare, but can run in families.
“When the normal flow of bile is blocked, it starts to build up, and some of it leaks into the bloodstream ―– this can make the skin very itchy.”
One symptom of cholestasis is lower water levels in the womb. My doctor did an ultrasound scan, and we found that the fluid levels levels were indeed lower. We also did a blood test on my liver ― the results showed that my aminotransferase (ALT) results were six times higher than usual, while my aspartate aminotransferase (AST) results were twice as high. This confirmed the cholestasis diagnosis as ALT and AST are indications of bile acid levels.
My husband and I were worried as the blood test results weren’t good, nor was this a common condition among pregnant women here. Furthermore, obstetric cholestasis may increase the chances of a stillbirth. There is also an increased risk of your baby passing meconium while he is in the womb, which can irritate the baby's lungs if he breathes it in during delivery.
My gynae suggested that we make tentative plans to get my baby out earlier if needed, especially if my condition started to affect his health.
I was advised to keep myself as hydrated as possible, as this would help to flush out my liver. The treatment of the condition is mainly symptomatic, such as ways to relieve the itch, and monitoring baby till it can be delivered.
The only cure for cholestasis is to deliver the baby.
Like any other worried parent, I Googled about the condition, so that I could find what other mums experienced, and whether there was anything else that could be done. But nothing really gave me more information than what my gynae had already told me.
The worst part of cholestasis was not the itch ― not knowing what was going to happen next was worse! I started to pay even more attention to my baby’s movement and his kicks, in case there were signs that he was in distress. I got paranoid about small changes, like if he was kicking less, or not moving for some time. I kept thinking that this might indicate a problem.
After I was diagnosed, I started seeing my gynae every week. Each time, we would do a scan as well as a blood test to see how my liver was functioning. I looked forward to each of my gynae visits because it would give me an idea of how my baby was doing and whether the condition was being managed.
“I got paranoid about small changes, like if he was kicking less, or not moving for some time.”
Thankfully, my liver results started improving.
By the time I was due to deliver my son, my liver results had normalised. However, the water level in my uterus was decreasing rapidly. By the time my baby was due, I could see, even through the scan, that the water level was barely enough.
Together with our gynae, we decided to deliver Jerome via a C-section at 36 weeks.
I had to take a steroid jab when I was 34 weeks pregnant to help mature his lungs since I was delivering him early. Thankfully, he was of a relatively bigger size and weight.
You can just imagine my sense of relief, when Jerome was finally out and gave his first cry in the operating theatre.
He was of a good size and appeared well, which was very good news for my husband and me.
My doctor mentioned that if a patient has cholestasis during her first pregnancy, she is likely to have it in her subsequent pregnancies, plus, the onset would be earlier.
If we do decide to have another child, it would be something we’d definitely have to watch out for it.
But after this experience, I know that I will be prepared to manage the condition if I do have it again ― and for this, I’m thankful.”
Germaine Tan, 34, is mum to Jerome, 4 months, and Claudia, 2.
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