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Obstetric cholestasis

What is obstetric cholestasis ?

Obstetric cholestasis (OC) is an uncommon pregnancy condition that affects your liver and makes you feel itchy, sometimes intensely so. You may also hear OC called intrahepatic cholestasis of pregnancy (ICP).

In the UK, OC affects about one in 150 mums-to-be (Kenyon et al 2010, RCOG 2012). It happens more often if you are of Indian-Asian or Pakistani-Asian origin, affecting about one in 70 women (RCOG 2012).

What causes OC?

We still don't know exactly what triggers OC. We do know that OC happens as a result of the way your body uses bile, a liquid produced in your liver. Bile helps to break down food, in particular fats, in your gut.

Normally, bile flows down a tube (the bile duct) into your intestines. If you have OC, less bile flows into your intestines. That means bile acids (also sometimes referred to as bile salts) start to build up in your body (NHS Choices 2012, RCOG 2012).

Some experts think OC is caused by the hormones oestrogen and progesterone. Your body may be sensitive to high levels of these hormones, and this may affect how your liver works (Azzaroli et al 2011, Mackillop and Williamson 2010, RCOG 2012).

There may also be a genetic link. OC sometimes runs in the family. It is more common in women of Indian-Asian and Pakistani-Asian ethnic origin (Mackillop and Williamson 2010, RCOG 2012).

How will I know if I have OC?

The main symptom of OC is itching, which is common in pregnancy and may be caused by something minor. In OC, it's often the palms of your hands and the soles of your feet that get itchy (Lee and Brady 2009, NHS Choices 2012).

The itching can be intense, and worse at night. There is not a rash, although you might scratch so hard that you break your skin (NHS Choices 2012).

A few women with OC develop jaundice, which makes you feel generally unwell. Jaundice causes your skin to be yellow-tinged, because of the changes happening in your liver. It can also turn your wee dark and make your poo pale (RCOG 2012).

The first step is to tell your midwife or doctor so they can rule out other possible causes of your itching. If OC is suspected, you'll have some blood tests. These tests will check how your liver is working and measure the level of bile salts in your body. You may itch for several weeks before liver or bile problems show in tests, so these may need to be repeated (RCOG 2011, 2012).

Other conditions, such as viral infections, can cause liver problems. So your doctor may offer you blood tests to rule these out before deciding it's likely you have OC (RCOG 2012).

There could be another reason why the flow of bile into your gut is blocked. An ultrasound scan can check whether something else, such as gallstones, is contributing to the problem (RCOG 2012).

How will having OC affect me?

Having OC is unlikely to harm you (Azzaroli et al 2011) , but the itching can be very uncomfortable. It helps to know that the itching should disappear soon after your baby is born (Azzaroli et al 2011).

The itching is often worse at night, and can be anything from mild to severe. It can keep you awake at night, leaving you exhausted (Geenes and Williamson 2009, RCOG 2012).

Sometimes, OC can affect your blood's ability to clot. So if you have any bleeding, it would take longer to stop. Your doctor may offer you vitamin K during your pregnancy (Lee and Brady 2009, RCOG 2012). Vitamin K plays an important part in making your blood clot.

If you have OC, your care should be led by a consultant and you will have extra tests and antenatal checks. You will be advised to give birth in a hospital that has a consultant-led maternity unit and a neonatal unit (RCOG 2012).

How will OC affect my baby?

One of the main concerns with OC is that your baby might be born early (Mackillop and Williamson 2010). One in 10 women with OC has her baby before 37 weeks.

This could happen because you go into premature labour, or because your doctor thinks it is safer for your baby to be born before your pregnancy reaches full-term (RCOG 2011, 2012)

If you have OC, your baby is more likely to pass her first poo (meconium) before she is born, which can cause breathing problems for her (Mackillop and Williamson 2010, RCOG 2011).

You'll be offered more antenatal appointments so that your doctor and midwife can monitor your pregnancy carefully. The checks and tests may include:

You will also be offered continuous heart rate monitoring for your baby during labour (RCOG 2011, 2012).

Your doctor may advise you to have your labour induced early (RCOG 2011,2012). Whether or not your labour is induced may depend on your blood tests, how you are coping with the itching and how well your baby is doing (RCOG 2011). Sometimes, it's hard to decide whether or not inducing labour is a good idea. Your doctor or midwife should discuss the pros and cons with you, to help you decide what's best for you and your baby.

How is OC treated?

The only cure for OC is giving birth, so the best your doctor can do is help you to cope with the symptoms. She can give you creams and possibly antihistamine tablets to help with the itching (RCOG 2012).

You may be offered a drug called ursodeoxycholic acid. It's commonly used for OC, although there is not enough clear evidence to say how well it works or how safe it is for your baby. This medication may ease the itching, help your liver to work properly, and reduce your bile salt levels (RCOG 2012).

Having OC can affect your blood's ability to clot. You may be offered vitamin K tablets to take daily, although not every woman with OC needs it. Vitamin K may help to reduce the small risk of bleeding heavily after you've had your baby.

It's not known how safe this is when your baby is in the uterus, so you may want to discuss this choice with your doctor. All babies are offered vitamin K shortly after birth, and this is a different situation. So you will also be offered this routine vitamin K for your baby after she is born (RCOG 2011,2012).

What happens after I give birth?

You'll have a follow-up appointment six weeks to eight weeks after the birth, to make sure the itching has gone away and your liver is working normally again (RCOG 2011,2012).

You may be advised to avoid some types of birth control pills, and your doctor can help you to find the contraception that works best for you (RCOG 2011,2012).

Unfortunately, there is a high chance that OC could happen again in future pregnancies (RCOG 2011,2012). It's an upsetting thought and it may help you to contact one of the organisations listed below – they understand what you are going through and they can give you lots of support.

Where can I find support?

Visit ICP Support, which helps women and families affected by this condition. You can contact the British Liver Trust and find information about OC from the Royal College of Obstetricians and Gynaecologists at You can also find support from others who have experienced OC in the BabyCentre community.

Last reviewed: July 2013



Azzaroli F, Turco L, Lisotti A et al. 2011. The pharmacological management of intrahepatic cholestasis of pregnancy. Curr Clin Pharmacol (1)

Geenes V, Williamson C. 2009. Intrahepatic cholestasis of pregnancy. World Gastroenterol 15(17)


Lee NM, Brady CW. 2009. Liver disease in pregnancy. World J Gastroenterol15(8):897-906


NHS Choices. 2012. Itching and obstetric cholestasis in pregnancy. NHS Choices, Health A-Z, Pregnancy and baby. [Accessed May 2013]



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I literally have itchiness in just my left hand and it's only at night. But it's soooo itchy.. Dunno what this could be?
I had oc with my 1st pregnancy and had to be induced 9 days before the due date of my baby. I suffered terribly with itchy feet and hands and also my stomach would itch all the time aswell but i thought this was down to stretch marks. It wasnt untill one day i was in my sisters and my vision started to go funny. It was blurred and then i went totally blind on my left side and could only see what was in front of me. I went to hospital where they done blood tests and sent me home only to phone me an hour later to tell me i had to go back and they were going to start me in the morning because i had a condition called oc. I am 9 weeks pregnant now and i am worried i am going to get oc again. X
I had OC when I was pregnant with my little boy and my doctor has put me on the pop pill, desomono. Can I safely take this? Because I'm currently experiencing sharp stabbing pains in my lower stomach Sophia x
I'm 31 weeks and suffering from this OC and its uncomfortable can't wait till I deliver my baby!
I have just googled itchy feet in pregnancy and ended up here im worried i may have oc im 27 weeks in first pregnancy and have not slept for 4 nights now.... Im scared to visit docs it just seems to be one complication aftet another

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