Hello XXXXXXX
Thanks for your query.

Your reports and symptoms are suggestive of a condition called cholestasis of
Cholestasis of pregnancy occurs in late pregnancy and triggers intense itching, usually on the hands and feet but sometimes on other parts of the body. Cholestasis of pregnancy can be intensely uncomfortable but poses no long-term risk to the mother. Cholestasis of pregnancy can be XXXXXXX for a developing baby, however. Early delivery is usually recommended.

The term "cholestasis" refers to any condition in which the flow of bile, a digestive fluid from the liver, slows or stops. Pregnancy is one of many possible causes of cholestasis. Other names for cholestasis of pregnancy include obstetric cholestasis and intrahepatic cholestasis of pregnancy.

Signs and symptoms of cholestasis of pregnancy may include:

Intense itching
Dark-colored urine
Light-colored bowel movements
Yellow eyes or skin
Often, however, intense itching — particularly on the palms of the hands and the soles of the feet — is the only symptom of cholestasis of pregnancy. The itching may be worse, even intolerable, at night. The itching is most common during the third trimester of pregnancy, but sometimes begins earlier.

The cause of cholestasis of pregnancy is unknown. However, the condition may be related to pregnancy hormones.

Bile — a digestive fluid that helps the body break down fats — is produced in the liver and stored in the gallbladder. Pregnancy hormones can affect how well the gallbladder functions. Sometimes, pregnancy hormones slow or even stop the flow of bile. Eventually, this excess bile may enter the bloodstream.

Factors that increase the risk of developing cholestasis of pregnancy include:

A personal or family history of cholestasis of pregnancy
A history of liver damage
A twin pregnancy
A pregnancy achieved by in vitro fertilization
After you've had the condition once, the risk of developing it during a subsequent pregnancy may be as high as 70 percent.

For mothers, cholestasis of pregnancy may temporarily hinder the absorption of fat-soluble vitamins. Itching usually resolves within a few days of delivery, and subsequent liver problems are uncommon — although cholestasis is likely to recur with other pregnancies.

For babies, the complications of cholestasis of pregnancy can be much more severe. For reasons not well understood, cholestasis of pregnancy increases the risk of preterm birth and meconium — a substance that lines the baby's intestines during pregnancy — in the amniotic fluid. If a baby inhales meconium during delivery, he or she may have trouble breathing. There's also a risk of sudden and unexplained fetal death late in pregnancy. Because of the potentially severe complications, labor is typically induced early, when the pregnancy crosses 37 - 38 weeks.

The treatment given is perfect as Udiliv enhances the clearance of bile, and Allegra improves itching. You can use local aloe Vera gel or lacto calamine for itching.

If the LFT or itching does not improve, you would be advised induction of labour, which is the right course.
Please be very particular about the baby's movements,
After each meal, breakfast, lunch and dinner, lie on the left lateral side and count baby movements,
The total per day should exceed ten movements.

Monitor well being of baby with ultrasound and colour Doppler.

Go for regular ante natal visits.

Take care, and feel free to ask for further clarifications.

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Hi XXXXXXX
Thanks for the appreciation.
I should have clarified, the rash also disappears within a few weeks of delivery.
About the scarring part, if you itch too hard , and cause secondary infection on it, then scarring occurs.
Otherwise, the skin returns to normal after the baby is born.
Try not to itch vigorously.
Use lacto calamine and take anti itch medicine as advised.
All the best.

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