The causes of cholestasis are not clear, therefore the choice of treatments can vary, and there is much debate about their efficiency and safety. Medications may include
antihistamines and tranquillisers, which are aimed at making the woman more comfortable, rather than actually curing the problem. If the baby is premature, the woman may be given
steroid injections, to help mature the baby's lungs. Unfortunately, the woman's liver can be further affected by these medications, making their use questionable.
The main aim of most caregivers is to closely monitor the woman during the pregnancy (usually through regular blood tests) and to monitor the baby (usually through ultrasounds and
CTG's). There is often a need to balance the decision about letting the pregnancy continue, (until labour starts of its own accord), or inducing a premature baby (less than 37 weeks). This is usually weighed up on a week by week basis.
If the baby starts to show signs of distress, or the woman's blood tests become extremely abnormal, the decision is often made to induce the labour. It is generally recommended not to allow the pregnancy to progress past 38 weeks, to reduce the chances of stillbirth. You may wish to read more about induction of labour in
Class 4.
Women with cholestasis have a higher chance of requiring a Caesarean birth. This is because of the increased chances of the baby becoming distressed during labour. It is for this reason that the baby's heart rate will usually need to be continuously monitored during the labour. You may wish to read more in
monitoring in labour.
There has been some research done using a new drug called 'ursodeoxycholic acid'. It tends to reduce the severity of cholestasis and prolong the pregnancy until
term, reducing the incidence of a premature baby and possibly reducing the stillbirth rate. Ursodeoxycholic acid is an experimental drug, and the affects on the baby, or the mother, are unknown at this stage.