Most pregnancy itching is from stretched, dry skin - completely harmless. But a specific pattern of intense itching, especially on the palms and soles and worse at night, can be obstetric cholestasis (OC). OC is a liver condition that slows the flow of bile, causing bile salts to build up in the blood and deposit under the skin.
Symptoms of Obstetric Cholestasis
- Intense itching on the palms of the hands and soles of the feet
- Itching all over the body without a rash
- Symptoms are worst at night and may prevent sleep
- Occasionally: dark urine, pale stools, or mild jaundice
- Usually starts in the third trimester, most often after 30 weeks
This is not normal itching
Skin stretching causes itching around the belly, breasts, and thighs - and a rash may appear (called PUPPP). Cholestasis itching is different: it is on the palms and soles, there is no rash, and it is relentless.
Why It Needs Monitoring
OC is associated with a higher risk of preterm birth, fetal distress, and in severe cases, stillbirth. The risk is greatest with very high bile acid levels. Most hospitals in Singapore will monitor bile acids regularly and often recommend early delivery between 37-38 weeks if OC is confirmed.
| Bile Acid Level | Management Approach |
|---|---|
| Below 40 micromol/L | Regular monitoring, medication considered |
| 40-99 micromol/L | Closer monitoring, usually deliver at 37-38 weeks |
| 100+ micromol/L | Highest risk - close hospital monitoring, early delivery likely |
Treatment
Ursodeoxycholic acid (UDCA) is the medication most commonly used. It helps bile flow more normally and reduces itching in most women. Topical creams (like calamine) provide some relief but do not treat the underlying cause.