It's no secret that during pregnancy a woman's body is experiencing very heavy loads.Moreover, the dramatic hormonal changes often leads to some complications.In modern obstetric practice sometimes found disease called cholestasis of pregnancy.In the absence of timely treatment of such condition can be dangerous for a growing child and for the mother's body.
That is why many expectant mothers interested in questions about what is this disease and why it occurs.What are the main symptoms?What treatment can offer modern medicine?Are there effective methods of prevention?This information will be of interest to many readers.
What is cholestasis?
cholestasis of pregnancy - a disease that is accompanied by dystrophic lesions of the liver tissue.This violation occurs against a background of increasing the sensitivity of hepatocytes to sex hormones, whose level varies significantly during childbearing.The result of this process is a violation of the normal processes of metabolism of cholesterol and bile a
Many expectant mothers are faced with a similar diagnosis.But do not immediately frightened, because in most cases with cholestatic hepatosis (also known as the disease) can be overcome by means of conservative medicine without causing any harm to the body of the woman or the child.
Immediately it is worth noting that in some countries the violation is really very common.For example, according to the statistical studies in Scandinavia, China, Bolivia and Chile are suffering from such diseases, many expectant mothers.But in Sweden on 10 000 pregnant women account for no more than 40 cases of this disease.
In Russia cholestasis during pregnancy is also considered a relatively rare complication - its frequency does not exceed 2%.The only exceptions are the northern regions of the country where the disease is diagnosed more often.Based on these data, the researchers suggest that the risk groups include women ethnicity.
main causes of the disease
In fact, until the end of today do not know why it develops intrahepatic cholestasis of pregnancy.There are many theories and research, thanks to which we can distinguish three main groups of reasons:
- increased sensitivity of hepatocytes to the group of sex hormones, which is due to genetic differences;
- inborn errors of the normal synthesis of enzymes that provide the transport of bile components from the hepatocytes into the bile ducts;
- congenital disruption of synthesis of bile acids associated with a deficiency of certain enzymes.In turn, such a disorder leads to the formation of atypical bile acids.
It should be noted that patients with a genetic predisposition or congenital disorders cholestasis is observed not only during pregnancy, but also for any change in the level of sex hormones (for example, during menstruation, receiving oral contraceptives).
pathogenesis of cholestasis.What happens during an illness?
cholestasis of pregnancy is accompanied by three major violations:
- improving elements of the bile in the blood;
- reduction of secretion in the intestine;
- bile toxic effects on the cells of the liver and biliary ducts.
disrupt the normal synthesis and outflow of fluid produced by the liver, due to the sharp increase in the level of progesterone and estrogen.Such hormonal changes slow the natural movement of bile even in normal pregnancy.And if there is risk of birth defects, degenerative changes of the filter body is significantly increased.In addition, excess hormones acts on the pituitary gland, reducing its activity.In turn, this changing work cancer affects the allocation process liver bilirubin, and cholesterol.This leads to disruption of the mechanisms of formation and excretion of bile.
Classification of diseases
Today, there are many systems of classification of this disorder.For example, depending on the severity of symptoms, isolated mild, moderate and severe forms of the disease.
By the nature of cholestasis can be both acute and chronic (in chronic disease develops on the background of pregnancy aggravation).Depending on the etiology distinguish extrahepatic (developed in the form of obstruction of the bile ducts) and intrahepatic cholestasis (these form occurs in pregnant women).
cholestasis of pregnancy: symptoms and signs
Any deviation from the norm in this period of life requires examination and consultation.So it looks like cholestasis of pregnancy?
Symptoms usually start to disturb in the third trimester (28-35 weeks.).The main manifestation of the disease is a skin itch, and it can have different degrees of severity.Some patients tolerate this violation easy, while others suffer from constant, painful discomfort.
Itching becomes more pronounced at night, which leads to insomnia and, accordingly, constant fatigue, irritability, emotional disorders.Most often this feeling is localized on the skin of the hands, arms, legs and the anterior abdominal wall.Cholestasis of pregnancy (photos are presented in medical directories) leads to excoriation of the skin, as women damage as a result of their constant scratching.
to other symptoms of the disease include jaundice.According to statistical studies, such disorders is observed in 10-20% of women.As a rule, all signs of disappear by themselves within 1-2 weeks after birth.Nevertheless, they may be resumed later on a background of hormonal failure (for example, during the second pregnancy).
main diagnostic methods
the presence of certain abnormalities should immediately consult a doctor.First, gather the expert's full medical history and a physical exam.Some women may be noted a little jaundice and characteristic staining of the sclera eyes.On examination, the skin may notice redness, abrasions caused by scratching the skin.
All these signs indicate that the patient can be cholestasis of pregnancy.Analyses of the concentration of serum bile acids may confirm suspicions of violations of the liver.There are also a variety of biochemical studies on the content and the activity of liver enzymes.Ultrasound is also shown, in which noted an increase in the volume of the gallbladder along with the normal size of the liver and homogeneous echogenicity.
Which complications can cause disease?
in modern medical practice are often faced with the problem called cholestasis of pregnancy.Is it dangerous to such a state?Of course, yes.Although it all depends on the severity of the pathological process, the time of diagnosis, therapy and so selected. D.
Nevertheless, the risk is always there.Violation of education and elimination of bile affects the metabolism.With such a high probability of disease of premature birth.In addition, the percentage of postpartum haemorrhage among women with similar diagnosis also significantly higher, due to the metabolism of vitamin K and some coagulation factors.
case of serious malfunctions of the liver there is a risk of fetal death, so in some cases, doctors recommend immediate delivery.
Drug therapy during pregnancy
Treatment depends on the severity of the disease and the individual characteristics of the patient.As a rule, first prescribed herbal hepatoprotectors that protect the liver from damage and do not harm the body.For example, "Hofitol" with cholestasis of pregnancy gives good results.In addition, drug therapy using "Gepabene".
addition to herbal medicines and is also used synthetic hepatoprotectors in particular "Ademethionine."As antioxidants administered during pregnancy tocopherol acetate (vitamin E) and ascorbic acid (vitamin C).In addition, it is necessary for the binding reception ehnterosorbentov excess bile acids in the intestine.Efficacy and safety of a drug is considered "Polyphepan."The therapy consists of drugs that facilitate the flow of bile and reduce the level of bile acids in the blood.In particular, use medicines containing ursodeoxycholic acid, for example, "Ursosan".
cholestasis of pregnancy: the treatment of drug-free means
addition to medications used, and some other therapies.In particular, pregnant women often prescribe a course of plasmapheresis and hemosorption.These procedures are designed to remove excess bilirubin from the blood and pruritogenov that cause itching.Such manipulation gives a really good result.A full course of treatment usually consists of four procedures and one plasmapheresis hemosorption.
Proper diet - an important part of therapy
Of course, after the diagnosis of the doctor select the most effective and harmless means of treatment.But no less important part of treatment is diet.If cholestasis of pregnancy must first take care of the diet that will reduce the burden on the liver.
Patients recommended to reduce the amount of fat of animal origin.In particular, it is necessary to limit consumption of fatty meats, butter, dairy products.You should also give up the mayonnaise, sauces and fried foods.Since the fat is still necessary for the normal development of the fetus, their deficiency can be avoided by eating vegetable matter (olive oil, and so on. D.).
also contraindicated in green tea, coffee and drinks Bile.Experts recommend to take time off from eggs, olives, beans, avocado, pickled products, radish, melon, color and Brussels sprouts.
diet should nevertheless be full of vitamins and minerals which may be obtained from fresh fruits and vegetables - they should be the basis diet.Allowed to eat porridge, fish, lean meats.Useful are the products containing high doses of vitamin C, such as oranges, spinach, parsley, broth from the hips, and so on. D. Need to eat often, but in small portions.It is also important to maintain fluid balance.
there effective preventive measures?
Many women are interested in questions about whether we can somehow prevent cholestasis of pregnancy.Unfortunately, there are no tools that can protect against such violations.Therefore, patients who are at risk, it is recommended careful monitoring throughout pregnancy.
Even before the first symptoms of the women assigned to receive mild hepatic, antioxidants and choleretic.It is also extremely important to follow the right diet.And, of course, the future mother should undergo regular examinations and tests to pass, as it will provide an opportunity to detect abnormalities at an early stage.
How to cope with the symptoms?Recommendations patients
Many women are faced with a diagnosis of "cholestasis of pregnancy."Reviews patients suggests that treatment really helps to eliminate the violations and maintain a healthy fetus.Nevertheless, constant itching significantly impairs quality of life.
fight this feeling can be with special packs.For example, lotions and masks from broth chamomile or oatmeal help eliminate discomfort and positive effect on the appearance of the skin, reduce inflammation.Also helps lotions from a simple cold water, because the low temperature slows down the blood flow, relieve itching.Patients also recommend sleeping in a ventilated, cool place and, of course, carefully follow the diet.