(Disclaimer: This article is for scientific use only, and the information in the following content has been processed to protect patient privacy)
Abstract: Pruritus in pregnancy is a unique complication of pregnancy, mostly caused by intrahepatic cholestasis during pregnancy. It manifests as unexplained pruritus of the skin in pregnant women in mid- to late pregnancy, and examination of biochemical tests results in elevated total serum bile acids, which may lead to fetal distress, preterm delivery, and intrauterine fetal death. As in this case, the patient was diagnosed with intrahepatic cholestasis of pregnancy and fetal distress. The patient came to the clinic with unprovoked persistent itching and increased fetal movement, which was controlled with medication and the itchy skin symptoms were significantly relieved.
Basic information】Female, 26 years old
Type of disease】Pregnancy pruritus, intrahepatic cholestasis during pregnancy, fetal distress
Hospital】Jiangbin Hospital of Guangxi Zhuang Autonomous Region
Date of Consultation】May 2022
【Treatment plan】Medication (ursodeoxycholic acid + dexamethasone + lactated Ringer’s solution + vitamin C + glyburide lotion) + oxygen absorption
Treatment Period】Hospitalization for 7 days, regular outpatient maternity checkup
Treatment effect】The condition has been controlled and the itchy skin has been significantly relieved
I. Initial consultation
A pregnant woman reported that she was 30 weeks of menopause and started to have mild itching on the palms of her hands and abdomen 10 days ago with no obvious cause. Yesterday, the itching symptoms started to worsen, and the small red dots on the abdomen were more obvious than before, and the itching at night made it difficult to sleep, and the number of self-counting fetal movements also increased significantly. She was diagnosed with single live fetus at 30 weeks of gestation, intrahepatic cholestasis during pregnancy, fetal distress and pruritus of pregnancy.
II. Treatment history
We explained to the pregnant woman and her family that pruritus was caused by intrahepatic cholestasis during pregnancy, and that this disease could lead to fetal distress, preterm delivery, intrauterine death, intracranial hemorrhage of the newborn, and postpartum hemorrhage of the mother. The pregnant woman agreed to actively cooperate with the treatment and was given bile acid-lowering treatment, such as ursodeoxycholic acid, immediately after admission; and topical medications were given to relieve pruritus, such as glycopyrrolate lotion. Since intrahepatic cholestasis during pregnancy can lead to fetal distress and intrauterine death, early termination of pregnancy is required if necessary depending on the change in the condition. The fetus is not yet full term at 30 weeks of gestation, so she was given fetal lung maturation drugs, dexamethasone for 2 days, and given oxygen and fluids, lactated Ringer’s solution and vitamin C daily to correct fetal hypoxia, and improved fetal heart monitoring and fetal ultrasound to detect fetal condition.
III. Treatment effect
After 3 days of treatment, the fasting serum total bile acid of 17.2µmol/L was rechecked, the pregnant woman felt that the fetal movement was back to normal, the fetal monitoring indicated that the fetal heart was normal, and the pregnant woman felt that her itching symptoms were reduced. After the treatment, the bile acid level of the pregnant woman decreased, the itching was reduced, and the fetus was in good condition, indicating that the treatment was effective, and symptomatic treatment was continued. After 6 days of treatment, the fasting serum total bile acid was rechecked at 8.8 µmol/L. The fetal ultrasound showed a late intrauterine pregnancy with a single live fetus, equivalent to 29 weeks and 1 day of gestation, and the fetal monitoring showed a normal fetal heartbeat. At 7 days of hospitalization, the patient was discharged from the hospital and was advised to have regular outpatient obstetric checkups.
IV. Notes
We are glad that the patient’s condition was relieved after medication to ensure the health of the patient and the fetus, but we suggest that the patient still needs to pay attention to the following matters after discharge.
1.Regular maternity checkups, blood needs to be drawn every 1-2 weeks to recheck total serum bile acid and liver function, fetal ultrasound every 1 month, regular ultrasound to understand fetal development, and regular fetal monitoring to understand whether there is fetal hypoxia.
2, avoid dry skin, drink more water, never scratch the skin, skin breakage may occur after infection, can use the appropriate amount of symptomatic topical drugs for anti-itch treatment, such as Benadryl cream.
3. pay attention to strengthening nutrition, it is recommended to focus on light and nutritious food, eat more fresh vegetables and fruits, and eat less spicy and stimulating, greasy food.
4. It is recommended to relax, ensure sleep, combine work and rest, and live regularly.
V. Personal insight
If unexplained skin itching occurs during pregnancy, and the itching cannot be relieved after scientific skin care methods, pregnant women should not think that it is just an ordinary skin problem, but should pay attention to it, and should go to the hospital promptly to check whether there is intrahepatic cholestasis during pregnancy. If intrahepatic cholestasis during pregnancy occurs, it should be treated actively with medication under the guidance of the doctor. Early medication treatment is effective, as in the case of this patient, to provide effective relief, reduce skin itching, and reduce the adverse effects of bile acid toxicity on the fetus, and smoothly pass the pregnancy period.