Cholestasis of pregnancy is when bile acid affected by hormones build up in the liver and then spill over in to the bloodstream. Generally, women come to the doctor complaining of severe itching of the hands and of the soles and of the feet. But, other symptoms can include dark urine, light stools, pain on the right upper quadrant, fatigue, nausea. And, at the point, the doctor does a thorough evaluation and sends off lab test for bile results, bile acids. You're predisposed to having cholestasis of pregnancy if you've had it with the previous pregnancy that makes you much more likely to get it again, or if you have a family history, or have any conditions of your liver or liver diseases. Once you have been diagnosed of cholestasis of pregnancy, generally for the mother, the worst part is the itching. So, we can prescribe steroid, steroid creams and different things to help relieve the itching. Unfortunately, for the baby, the consequences can be worse. Cholestasis of pregnancy can be dangerous for the unborn child because the fetus needs the mother's liver as well. And, if the liver is backed up with the bile acids, the baby can't use the mother's liver as it needs to. So, cholestasis of pregnancy can increase the baby's risk of fetal distress and even still born. So, what do we do about it besides getting the mother to have symptom relief from all the itching? Well, if the mother is full term, she's passed 36, 37 weeks of gestation, we feel that it would be safer for her to deliver than for the baby to stay inside, we generally offer her delivery. If the baby is premature, we have to weigh the prematurity with the benefits of delivery and we can hold off for as long as it's safe by monitoring the baby, checking the mother's blood levesl to see if the cholestasis is getting worst or improving, and, if necessary and we think that early delivery is going to take place, trying to monitor the baby for the 48 hours that would be necessary to get steroids on board to mature the baby's lungs before delivery. At the end of the day, if a woman thinks that she has any signs or symptoms of cholestasis, she definitely needs to present to her doctor or midwife and be evaluated. Now, it's important to remember that pregnant women do have a lot of itching and the majority of the time that women have itching, it's not cholestasis of pregnancy. But, you do wanna make sure that you get that ruled out if you're concerned. Another symptom that's not common, the canacker with cholestasis is jaundice where the skin and even the whites of the eyes can become yellow. This, depression, these can be additional symptoms.