Pregnant women with itchy skin, beware of intrahepatic cholestasis during pregnancy

  Xiaowei is 27 years old this year and is pregnant with a pair of single-egg twins. The family is very happy. But at 28 weeks of pregnancy, she had to be admitted to the hospital because of threatened premature delivery. After a week of fetal pregnancy treatment, the doctor said that he could be discharged from the hospital, but that night, Xiao Wei suddenly felt that her skin was itchy all over her body. “At first it was two palms, the soles of the feet, then the arms and legs, and then the whole body was itchy. I can’t see pimple or rash, but it is itching.” After hearing about her condition, the attending doctor advised her to check her liver function. Xiao Wei is puzzled, how does the skin itch and liver have a relationship? Moreover, the liver function has been checked on admission, it is normal! However, she still obeyed the doctor’s advice. As a result, her alanine aminotransferase was as high as 124U/L (international units/liter), aspartate aminotransferase 74U/L, and total bile acids 32.3 micromoles/liter. She was diagnosed with severe intrahepatic bile during pregnancy. For stasis, it is definitely impossible to leave the hospital on the same day. Bile acid reduction and liver protection treatment must be performed first.
  Skin itching is very common, but when pregnant women experience itching, beware of intrahepatic cholestasis during pregnancy. Intrahepatic cholestasis of pregnancy is an idiopathic complication in the middle and late stages of pregnancy. The clinical manifestations are characterized by skin pruritus and elevated serum total bile acids. The pruritus is usually persistent, starting from the soles of the feet and hands, and as the disease progresses It gradually extends to the proximal limbs, and some patients may also experience itching on the face. In addition to itching, 10% to 15% of patients will be accompanied by mild jaundice, which is usually not exacerbated by the increase in gestational age, but whether it is accompanied by jaundice symptoms and the prognosis of the fetus has a certain correlation. Increase the perinatal mortality rate, neonatal asphyxia rate and amniotic fluid fecal staining rate.
  Intrahepatic cholestasis of pregnancy is a benign disease for pregnant women. After pregnancy, the symptoms will gradually disappear. Some women may reduce the bile acid in the intestines, which affects the absorption of vitamin K and causes the synthesis of certain coagulation factors to decrease. , Bleeding after delivery; but may cause serious adverse effects on the fetus, because the toxic effects of bile acid will endanger the safety of the fetus, increase the risk of premature delivery, stillbirth and neonatal asphyxia. Therefore, if pregnant women have skin itching, they must carefully distinguish whether it is intrahepatic cholestasis of pregnancy or ordinary skin disease. The diagnosis of intrahepatic cholestasis during pregnancy is not complicated. It can be diagnosed by liver function testing. Most patients have mild to moderately elevated aspartate aminotransferase and alanine aminotransferase, which are 2-10 times the normal level. .
  If it is diagnosed as intrahepatic cholestasis of pregnancy, immediate treatment is needed to improve liver function, lower blood bile acid levels, relieve itching symptoms, prolong gestational weeks, and improve pregnancy outcome. You can take cholestyramine, phenobarbital or Drugs such as dexamethasone and the traditional Chinese medicine Yinchen Decoction have better therapeutic effects, which can reduce the blood bile acid level and its adverse effects on mothers and children. Before 34 weeks of pregnancy, doctors will also give some drugs to promote fetal lung maturity according to the situation to prevent the risk of premature birth and avoid respiratory distress syndrome in premature babies. Once it is found that the reduction or disappearance of fetal movement is a danger signal of fetal hypoxia, it needs to be dealt with immediately. The timing of pregnancy termination is generally assessed by doctors following the principle of individualization through comprehensive consideration of gestational age, severity of the condition, and treatment effects.
  Pregnant women themselves need to pay attention to daily life and diet: understand the knowledge of the disease to relieve the fear of the disease, so that the physical and psychological are in the best treatment state; need to pay attention to rest, take the left side lying position to increase placental blood Flow, improve the fetal hypoxia; you can divert attention by listening to music, reading, doing manual work, etc., to relax the body and mind; do not use drugs without authorization, beware of drugs that cause fetal malformations or drug-induced dermatitis. If the itching is more serious, You can use menthol, camphor cream, etc. under the guidance of a doctor. If necessary, you can use hormone ointments with small side effects for a short time; while applying drugs to reduce itching, you should frequently change sheets and quilts to keep the bedding clean and dry; keep the skin Keep your hands clean and trim your nails twice a week to avoid infections caused by long nails scratching the skin; diet should control cholesterol diet, mainly low-fat, high-protein, high-vitamin, light diet, eat more vegetables and fruits, Drink plenty of boiling water.